Provider Demographics
NPI:1619979481
Name:PACE, SCOTT M (DPM)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:M
Last Name:PACE
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 1:43 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3933
Mailing Address - Country:US
Mailing Address - Phone:845-339-3338
Mailing Address - Fax:845-340-1074
Practice Address - Street 1:43 GRAND ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3933
Practice Address - Country:US
Practice Address - Phone:845-339-3338
Practice Address - Fax:845-340-1074
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006038213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02600484Medicaid
NYPJ4661Medicare ID - Type Unspecified
V01222Medicare UPIN