Provider Demographics
NPI:1053392258
Name:SILODOR, SCOTT W (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:W
Last Name:SILODOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 HAMBURG TPKE
Mailing Address - Street 2:224
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5043
Mailing Address - Country:US
Mailing Address - Phone:973-696-0998
Mailing Address - Fax:973-696-3247
Practice Address - Street 1:1211 HAMBURG TPKE
Practice Address - Street 2:224
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5043
Practice Address - Country:US
Practice Address - Phone:973-696-0998
Practice Address - Fax:973-696-3247
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06061500207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ191754OtherMEDICARE GROUP NUMBER
NJ2026619Medicaid
NJ149689AWSOtherMEDICARE RENDERING NUMBER
NJP1603435OtherOXFORD
NJ037893OtherMEDICARE GROUP
NJ0497752OtherAETNA
NJ2026619Medicaid
NJ149689Medicare PIN
NJF85632Medicare UPIN