Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD442563 | PA |
N | 111NI0900X | Internist | MD442563 | PA |
Y | 207RH0002X | Hospice and Palliative Medicine | MT193345 | PA |
NPI | 1396906483 |
---|---|
Provider Name | Dr. Scott D Freeman |
First Address | Mineola, NY 11501-3893 |
Second Address | Mineola, NY 11501-3893 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2008 |
Last Update Date | 20/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
037276 | MLHC MEDICARE AA # (01) | PA |
213-2359401 | MLHC TIN (01) | PA |
824305 | MLHC BS AA # (01) | PA |