Provider Demographics
NPI:1083697726
Name:SCHNEIDERMAN, HENRY (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:SCHNEIDERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE 2112/SAINT FRANCIS MEDICAL GROUP, INC.
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1770
Mailing Address - Country:US
Mailing Address - Phone:860-714-4749
Mailing Address - Fax:860-714-8439
Practice Address - Street 1:1000 ASYLUM AVENUE SUITE 2112
Practice Address - Street 2:SAINT FRANCIS MEDICAL GROUP, INC
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105
Practice Address - Country:US
Practice Address - Phone:860-714-4749
Practice Address - Fax:860-714-8439
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT023639207R00000X, 207RG0300X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001236397Medicaid
CT110003329Medicare ID - Type Unspecified
B84413Medicare UPIN
CT001236397Medicaid