Provider Demographics
NPI:1043247786
Name:SCHLOSSBERG, SEYMOUR (DO)
Entity Type:Individual
Prefix:DR
First Name:SEYMOUR
Middle Name:
Last Name:SCHLOSSBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MAYFAIR DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3703
Mailing Address - Country:US
Mailing Address - Phone:973-696-1555
Mailing Address - Fax:973-696-5677
Practice Address - Street 1:2 MAYFAIR DR
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3703
Practice Address - Country:US
Practice Address - Phone:973-696-1555
Practice Address - Fax:973-696-5677
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB01934200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC53108Medicare UPIN
NJ443700Medicare ID - Type Unspecified