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General NPI Number Information
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NPI Number | 1619962586
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Entity Type | Individual
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Provider Name | SCOTT IPPOLITO M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/15/2005
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Last Update Date | 04/27/2010
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Provider Practice Location Address
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Address Line | 196 MERRICK RD
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City | OCEANSIDE
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State | NY
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Zip | 11572-1420
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Country | US
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Telephone | 516-255-8400
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Fax | 516-255-8453
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Provider Business Mailing Address
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Address Line | 1 HEALTHY WAY ATTN: PHYSICIAN BILLING
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City | OCEANSIDE
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State | NY
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Zip | 11572-1551
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Country | US
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Telephone | 516-255-8400
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Fax | 516-255-4672
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 179201
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License Number State | NY
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