Provider Demographics
NPI:1881871762
Name:GAETANO J SCUDERI MD & ASSOCIATES
Entity type:Organization
Organization Name:GAETANO J SCUDERI MD & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GAETANO
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCUDERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-747-9334
Mailing Address - Street 1:1935 COMMERCE LN
Mailing Address - Street 2:SUITE #1
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-5858
Mailing Address - Country:US
Mailing Address - Phone:561-747-9334
Mailing Address - Fax:561-747-9633
Practice Address - Street 1:1935 COMMERCE LN
Practice Address - Street 2:SUITE #1
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-5858
Practice Address - Country:US
Practice Address - Phone:561-747-9334
Practice Address - Fax:561-747-9633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF49835Medicare UPIN