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General NPI Number Information
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NPI Number | 1245332782
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Entity Type | Individual
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Provider Name | VANDA R. SCOTT-JOHNSTON D.P.M.
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Gender | Female
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Dates
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Enumeration Date | 09/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 241 W 138TH ST GROUND FLOOR
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City | NEW YORK
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State | NY
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Zip | 10030-2102
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Country | US
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Telephone | 212-694-2392
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Fax | 212-694-4020
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Provider Business Mailing Address
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Address Line | 13445 166TH PL APT# 12B
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City | JAMAICA
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State | NY
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Zip | 11434-3854
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Country | US
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Telephone | 718-712-7496
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | N004013
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License Number State | NY
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