Provider Demographics
NPI:1063644557
Name:JEAN MARIE-SCHMITT, FREDERIQUE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:FREDERIQUE
Middle Name:
Last Name:JEAN MARIE-SCHMITT
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:MS
Other - First Name:FREDERIQUE
Other - Middle Name:
Other - Last Name:JEAN MARIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:38 EAST LINCOLN AVENUE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-7741
Mailing Address - Country:US
Mailing Address - Phone:347-639-9192
Mailing Address - Fax:
Practice Address - Street 1:16633 89TH AVE
Practice Address - Street 2:SUITE 1M
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4255
Practice Address - Country:US
Practice Address - Phone:516-851-6794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011218363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical