Basic Information
| Provider Information | |||||||||
| NPI: | 1881675692 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCARDINA | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2209 GENESEE ST. | ||||||||
| Address2: | BUSINESS OFFICE | ||||||||
| City: | UTICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 135015930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3158014238 | ||||||||
| FaxNumber: | 3158018391 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 HOBART ST | ||||||||
| Address2: | |||||||||
| City: | UTICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 135014308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157981149 | ||||||||
| FaxNumber: | 3158013565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 06/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0131X | 1449 | MA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery |
ID Information
| ID | Type | State | Issuer | Description | 700688 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 0336769 | 05 | MA | MEDICAID | Y70599 | 01 | MA | BCBS MA | OTHER |