Provider Demographics
NPI:1649341124
Name:SCRANTON, JOHN ROBERT (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:SCRANTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 EAST MAIN ST.
Mailing Address - Street 2:SOUTHSIDE HOSPITAL-DEPT. OF EMERGENCY MEDICINE
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706
Mailing Address - Country:US
Mailing Address - Phone:631-968-3314
Mailing Address - Fax:
Practice Address - Street 1:301 EAST MAIN ST.
Practice Address - Street 2:SOUTHSIDE HOSPITAL-DEPT. OF EMERGENCY MEDICINE
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-968-3314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176902207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02682864Medicaid
NY52F931Medicare ID - Type Unspecified
NY02682864Medicaid