Provider Demographics
NPI:1902974819
Name:SCOTTO DI CLEMENTE, MICHAEL JOSEPH (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:SCOTTO DI CLEMENTE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 TERRACE PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1104
Mailing Address - Country:US
Mailing Address - Phone:718-768-2768
Mailing Address - Fax:
Practice Address - Street 1:114 TERRACE PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-1104
Practice Address - Country:US
Practice Address - Phone:718-768-2768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005032A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP55512OtherEMPIRE
NYNPC38824OtherELDERPLAN
NY01635670Medicaid
NY0005820491OtherAETNA
NY6200984OtherGHI
NYP411909-P745761OtherOXFORD
NYP411909-P745761OtherOXFORD
NY01635670Medicaid