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General NPI Number Information
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NPI Number | 1700459807
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Entity Type | Individual
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Provider Name | SCOTT G SOLTIS
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Gender | Male
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Dates
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Enumeration Date | 07/19/2021
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Last Update Date | 07/19/2021
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Provider Practice Location Address
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Address Line | 9 E GATE DR
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City | GLENWOOD
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State | NJ
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Zip | 07418-2007
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Country | US
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Telephone | 732-640-5551
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Fax |
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Provider Business Mailing Address
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Address Line | 402 MAIN ST STE 100-289
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City | METUCHEN
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State | NJ
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Zip | 08840-1846
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Country | US
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Telephone | 732-640-5551
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number | C0840726
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License Number State | NY
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