Provider Demographics
NPI:1053375246
Name:REX, SCOTT L (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:L
Last Name:REX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BERNARD ST
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2902
Mailing Address - Country:US
Mailing Address - Phone:516-467-4788
Mailing Address - Fax:516-467-4793
Practice Address - Street 1:6 BERNARD ST
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-2902
Practice Address - Country:US
Practice Address - Phone:516-467-4788
Practice Address - Fax:516-467-4793
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233009-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I21203Medicare UPIN
NY1479P2Medicare PIN