Provider Demographics
NPI:1144525973
Name:BLEAZEY, SCOTT THOMAS (DPM)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:THOMAS
Last Name:BLEAZEY
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 1:8100 WESCOTT DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4671
Mailing Address - Country:US
Mailing Address - Phone:908-782-0600
Mailing Address - Fax:908-782-7575
Practice Address - Street 1:8100 WESCOTT DR
Practice Address - Street 2:SUITE 101
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4671
Practice Address - Country:US
Practice Address - Phone:908-782-0600
Practice Address - Fax:908-782-7575
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00321500213ES0103X
PASC006265213ES0103X
AZ0746213ES0131X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ716038Medicaid
AZZ90098Medicare PIN