Healthcare Provider Details

I. General information

NPI: 1881829224
Provider Name (Legal Business Name): STATEN ISLAND MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 BARD AVE
STATEN ISLAND NY
10310-1664
US

IV. Provider business mailing address

682 FOREST AVE
STATEN ISLAND NY
10310-2507
US

V. Phone/Fax

Practice location:
  • Phone: 718-370-3730
  • Fax: 718-698-9412
Mailing address:
  • Phone: 718-370-3730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number182840
License Number StateNY

VIII. Authorized Official

Name: DR. FRANK SCAFURI III
Title or Position: OWNER
Credential: D.O.
Phone: 718-370-3730