| Doctor Name: | THERESA SCOLARO |
| NPI Number: | 1508116369 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA |
| License Number: | 015759 |
| Business Practice Address: | 40 Laurel Ln Locust Valley, NY - 115602204 |
| Business Phone Number: | 5162382097 |
| Business Fax Number: | |
| Mailing Address: | 833 Northern Blvd, Suite 160 GREAT NECK |
| State: | NY |
| Postal Code: | 110215315 |
| Phone Number: | 5162382097 |
| Fax Number: | |
| NPI Enumeration Date: | 09/19/2012 |
| NPI Last Update Date: | 01/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | 015759 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |