Healthcare Provider Details

I. General information

NPI: 1043618895
Provider Name (Legal Business Name): SCOTT SOOLIM CHOI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2014
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 HILLSIDE RD
PELHAM NY
10803-2723
US

IV. Provider business mailing address

1234 ESTATES LN # 48M
BAYSIDE NY
11360-1140
US

V. Phone/Fax

Practice location:
  • Phone: 914-738-2400
  • Fax:
Mailing address:
  • Phone: 646-469-7978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number059776
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: