Provider Demographics
NPI:1144675711
Name:SCOPO, GENNARO THOMAS
Entity type:Individual
Prefix:MR
First Name:GENNARO
Middle Name:THOMAS
Last Name:SCOPO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 W 45TH ST APT 705
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-4191
Mailing Address - Country:US
Mailing Address - Phone:646-648-2818
Mailing Address - Fax:
Practice Address - Street 1:325 W 45TH ST APT 705
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4191
Practice Address - Country:US
Practice Address - Phone:646-648-2818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY713421163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse