Nicodemo Domenico Scarfo better known as "Little Nicky," was born in Brooklyn, New York on March 8, 1929. His father and three uncles, the Piccolos, were all made-men in the Genovese Crime Family. This meant they were untouchable, or protected members of the mafia. The Piccolos were capos under the Bruno Crime family, run by Angelo Bruno, known as the "Gentle Don" for his genial personality. Philadelphia was one of the major areas of operation for the American Italian Mafia. This was the beginning of Little Nicky's life of organized crime.

Not much is written about his education but schooling was not a priority for immigrant Sicilian families in the early 1900s, according to Howard Abadinsky's book Organized Crime. It is also not clear when Scarfo moved to Philadelphia. His first job was as a valet parking cars for elder mobsters, typically a rite of passage for young men making their way through the ranks of La Cosa Nostra. Scarfo became a member of the Bruno Family in the 1950s, later to become known as the Bruno/Scarfo Family. Scarfo got the nickname "Little Nicky" because he stood five feet five inches and weighed only 130 pounds. What he lacked in stature he made up in ruthlessness. According to his nephew and mob turncoat Philip Leonetti, Scarfo committed one of his first ordered murders in the early 1960's with an ice pick. He also stabbed and killed a longshoreman in 1963 for not relinquishing his seat in a Philadelphia diner. These heinous acts of violence were prequels to the violence Little Nicky would incite as Boss of the Philadelphia Family.

Scarfo was found guilty of involuntary manslaughter and served three months of a two year sentence. Abadinsky described Scarfo in a Philadelphia paper by saying, "He was a street thug, he had no managerial skills, he was stupid...and deadly." Scarfo's actions brought unwanted attention on the family and Angelo Bruno banished Nicky Scarfo to Atlantic City rather than have him murdered and upsetting his uncles. Scarfo was promoted to caporegime and organized his own crew in the struggling shore community. Scarfo's crew participated in any illegal activities that were available to them including gambling, extortion, prostitution, and involvement in labor unions.

In 1972, he served two years in prison for refusing to testify before the New Jersey State Commission of Investigation. Greater opportunities for illegal operations presented themselves to Nicky Scarfo in 1978 when Atlantic City legalized gambling. This allowed Scarfo and the greater Philadelphia Cosa Nostra to be involved in the building contracts of new casinos. According to testimony given to federal prosecutors and reported by The Philadelphia Inquirer, Scarfo's outfit would typically control materials and Labor unions and make sure that construction ran smoothly in exchange for a monetary kickback.

Angelo Bruno was killed in 1980 in an execution style hit outside of his house. This led to Underboss Philip Testa being named boss and Scarfo being promoted to Consiglieri, the third highest rank in the Philadelphia Family. It was a position of advisor to the boss. When Testa was killed by a nail bomb on March 15, 1981 his underboss, Peter Casella, was suspected of the plot. His bid for boss was unsuccessful and Nicky Scarfo forced him into retirement and was given the blessing of the Gambino and Genovese Families to take the reigns as boss of the Bruno Family in Philadelphia. Scarfo's term as boss became one of the most violent periods in the Philadelphia Cosa Nostra with close to 30 members and associates being killed, according to federal racketeering charges.

During his time as boss, Scarfo served another jail term of 17 months for an old gun charge and was released in 1984. Scarfo initiated a "street tax" on illegal activities such as bookmakers, loansharks, and drug dealers. Scarfo received a cut on all illegal activities in Philadelphia and South Jersey. At one point, five separate charges were brought against the mob kingpin in 14 months. In 1987, he was acquitted of federal drug conspiracy charges, but was later sentenced to 14 years for extortion. Then, in 1989, he was also found guilty of first degree murder in the 1985 killing of a rival Mafioso Frank D'Alfonso and sentenced to life in prison. Little Nicky's brutal rule led to many members of his family becoming federal informants and witnesses out of fear for their safety. Scarfo was eventually sentenced to a 14-year, 55-year, and a life term. His life sentence was eventually overturned and he is scheduled for release in January 2033 when he will be 104 years old. He now resides in the U.S. Penitentiary in Atlanta, Georgia.