Individual provider Active NPI

Steven A Scuderi, M.D.

  • Internal Medicine Physician
  • Medford, NJ
National Provider Identifier
1366421661
Registry record updated Sep 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA04785100 Issued in NJ
Practice address
103 Old Marlton Pike
Suite 111
Medford, NJ 08055-8772
Phone
(609) 953-7111
Fax
(856) 953-1544
NPI assigned
Jan 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 25MA04785100 NJ Primary

Addresses

Primary practice location

103 Old Marlton Pike
Suite 111
Medford, NJ 08055-8772

Mailing address

401 Route 73 N
40 Lake Center Drive Suite 201a
Marlton, NJ 08053-3425
Phone (856) 355-0340

Other identifiers 1

IdentifierTypeStateIssuer
0641308MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040320000162 NJ Practitioner - Internal MedicinePractitioner - Geriatric Medicine 5890696041 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25MA04785100NJMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Virtua Medical Group, PA CurrentSince Jul 1, 2010 Accepting new patients
Virtua Medical Group, PA Past Accepting new patients
Virtua Medical Group, PA Past Accepting new patients
Virtua Medical Group, PA Past Accepting new patients
Virtua Medical Group, PA Past Accepting new patients
Virtua Medical Group, PA Past Accepting new patients
Partners in Primary Care Inc Internal Medicine Past Accepting new patients
Virtua Medical Group, PA Past Accepting new patients
Virtua Medical Group, PA Past Accepting new patients

Locations

3242 Route 206
Ste 2
Bordentown, NJ 08505
Phone (609) 298-4340

534 Lippincott Dr
Marlton, NJ 08053
Phone (856) 355-7146

103 Old Marlton Pike
Ste 111
Medford, NJ 08055
Phone (609) 451-8088

175 Madison Ave
Mount Holly, NJ 08060
Phone (609) 261-1660

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1284076800000",
    "number": "1366421661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 ROUTE 73 N",
            "address_2": "40 LAKE CENTER DRIVE SUITE 201A",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080533425",
            "telephone_number": "856-355-0340",
            "fax_number": "856-355-0346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 OLD MARLTON PIKE",
            "address_2": "SUITE 111",
            "city": "MEDFORD",
            "state": "NJ",
            "postal_code": "080558772",
            "telephone_number": "609-953-7111",
            "fax_number": "856-953-1544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCUDERI",
        "first_name": "STEVEN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-13",
        "last_updated": "2010-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA04785100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0641308",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, NJ

Sources for this page

Verify at the official NPI Registry.