Provider Demographics
NPI:1043618895
Name:CHOI, SCOTT SOOLIM
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:SOOLIM
Last Name:CHOI
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 1:1234 ESTATES LN # 48M
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1140
Mailing Address - Country:US
Mailing Address - Phone:646-469-7978
Mailing Address - Fax:
Practice Address - Street 1:661 HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-2723
Practice Address - Country:US
Practice Address - Phone:914-738-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist