MEDICARE: SCOTT REX, MD, LLC.

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	207Q00000X	Family Medicine Physician	233009	NY

General Provider Information

NPI Number	:	1790966968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT REX, MD, LLC.

Provider Business Mailing Address
First Line	:	620 PORT WASHINGTON BLVD
Second Line	:
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-3714
Country	:	US
Telephone Number	:	516-467-4788
Fax Number	:	516-467-4793

Provider Business Practice Location Address
First Line	:	620 PORT WASHINGTON BLVD
Second Line	:
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-3714
Country	:	US
Telephone Number	:	516-467-4788
Fax Number	:	516-467-4793

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SCOTT LOUIS REX
Credential	:	MD
Telephone Number	:	516-467-4788

Provider Enumeration Date	:	11/16/2007
Last Update Date	:	08/06/2008

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