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Organization
LIFES BOUNTY MEDICAL CARE P C
Active
Organization
LIFES BOUNTY MEDICAL CARE P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNA MARIE SCOPELLITO-OLSEN (DOCTOR)
17186686963
Entity
Organization
Contact information
Practice address
1776 RICHMOND RD, STATEN ISLAND, NY 10306-2578
(718) 668-6963
Mailing address
96 MIDLAND RD, STATEN ISLAND, NY 10308-2918
(718) 668-6963
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
168980
NY
208000000X
Pediatrics Physician
168980
NY
Other
Enumeration date
12/21/2006
Last updated
12/12/2012
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