Provider Demographics
NPI:1609836964
Name:LURIE, SCOTT R (DPM)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:R
Last Name:LURIE
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 1:133 E 58TH ST STE 407
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1162
Mailing Address - Country:US
Mailing Address - Phone:212-753-3520
Mailing Address - Fax:212-753-3521
Practice Address - Street 1:133 E 58TH ST STE 407
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022
Practice Address - Country:US
Practice Address - Phone:212-753-3520
Practice Address - Fax:212-753-3521
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003765213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY24389GOtherMEDICARE PTAN
NYP39681Medicare PIN
NYT32108Medicare UPIN