MEDICARE: MR. HAROLD SCOTT JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	25MP00235300	NJ
2	363AM0700X	Medical Physician Assistant	C02722	MD

General Provider Information

NPI Number	:	1396719688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HAROLD SCOTT JR.

Provider Business Mailing Address
First Line	:	1 DIAMOND HILL RD
Second Line	:
City	:	BERKELEY HEIGHTS
State	:	NJ
Zip	:	07922-2104
Country	:	US
Telephone Number	:	908-273-4300
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 NEW RD
Second Line	:
City	:	LINWOOD
State	:	NJ
Zip	:	08221-1299
Country	:	US
Telephone Number	:	609-653-4343
Fax Number	:	609-653-2060

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	10/07/2022

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Directions to “ MR. HAROLD SCOTT JR. ” Practice Location

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