Provider Demographics
NPI:1043562887
Name:SCHOENHOLTZ, JACK CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:CHARLES
Last Name:SCHOENHOLTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:360 ORIENTA AVE
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-3936
Mailing Address - Country:US
Mailing Address - Phone:914-698-4332
Mailing Address - Fax:914-698-0184
Practice Address - Street 1:360 ORIENTA AVE
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3936
Practice Address - Country:US
Practice Address - Phone:914-698-4332
Practice Address - Fax:914-698-0184
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY094714-22084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY094714-2OtherNEW YORK STATE MEDICAL LICENSE NUMBER