Provider Demographics
NPI:1770746513
Name:SCOTT GINGOLD MD
Entity type:Organization
Organization Name:SCOTT GINGOLD MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:I
Authorized Official - Last Name:GINGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-422-6046
Mailing Address - Street 1:739 IRVING AVE
Mailing Address - Street 2:STE 660
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210
Mailing Address - Country:US
Mailing Address - Phone:315-422-6046
Mailing Address - Fax:315-422-6365
Practice Address - Street 1:739 IRVING AVE
Practice Address - Street 2:STE 660
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-422-6046
Practice Address - Fax:315-422-6365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181243207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000920516001OtherHEALTH NOW
NY01649783Medicaid
140004361OtherRR MEDICARE
3000679OtherGHI
956130OtherMVP
3000679OtherGHI
=========OtherBCBS
NY01649783Medicaid
AA0753Medicare PIN