Provider Demographics
NPI:1730245697
Name:PUGLIESE, SCOTT J (PT)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:J
Last Name:PUGLIESE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 EMPIRE BLVD
Mailing Address - Street 2:BLDG. #2
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-1957
Mailing Address - Country:US
Mailing Address - Phone:585-671-1030
Mailing Address - Fax:585-671-1991
Practice Address - Street 1:2000 EMPIRE BLVD
Practice Address - Street 2:BLDG. #2
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-1957
Practice Address - Country:US
Practice Address - Phone:585-671-1030
Practice Address - Fax:585-671-1991
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007744-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC0437Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER