Healthcare Provider Details

I. General information

NPI: 1801849666
Provider Name (Legal Business Name): MICHAEL SCANLON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 E 4TH ST
NEW YORK NY
10003-9001
US

IV. Provider business mailing address

96 E 4TH ST
NEW YORK NY
10003-9001
US

V. Phone/Fax

Practice location:
  • Phone: 212-677-8850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberN002978
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: