Healthcare Provider Details

I. General information

NPI: 1073614145
Provider Name (Legal Business Name): SCOTT A. MAYERBERGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 WILLIAM FLOYD PKWY STE 105
SHIRLEY NY
11967-1820
US

IV. Provider business mailing address

1490 WILLIAM FLOYD PKWY STE 105
SHIRLEY NY
11967-1820
US

V. Phone/Fax

Practice location:
  • Phone: 631-475-7700
  • Fax: 5-573-1408
Mailing address:
  • Phone: 631-475-7700
  • Fax: 800-557-3140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number198877
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: