Healthcare Provider Details

I. General information

NPI: 1730168774
Provider Name (Legal Business Name): LORETTA SCOTT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 CASTLETON AVE
STATEN ISLAND NY
10301-2709
US

IV. Provider business mailing address

99 LEVERETT AVE
STATEN ISLAND NY
10308-1724
US

V. Phone/Fax

Practice location:
  • Phone: 718-447-7800
  • Fax:
Mailing address:
  • Phone: 718-948-0138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF302486-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberF340378-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: