Healthcare Provider Details

I. General information

NPI: 1992741722
Provider Name (Legal Business Name): MARY SCIUTTO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 W 165TH ST INTENSIVE OUTPATIENT PROGRAM - EI 4TH FLOOR
NEW YORK NY
10032-3724
US

IV. Provider business mailing address

622 W 168TH ST BOX 260
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-9758
  • Fax: 212-305-4724
Mailing address:
  • Phone: 212-305-2330
  • Fax: 212-305-4724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number177674
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: