=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043673080
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEKA NICOLE SCOCO MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2016
-----------------------------------------------------
Last Update Date | 07/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | HSC, T-12, ROOM 080
-----------------------------------------------------
City | STONY BROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11794-2841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-444-1213
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HSC, T-12 ROOM 080
-----------------------------------------------------
City | STONY BROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11794-8122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-287-3332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | 323205
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------