Provider Demographics
NPI:1134458748
Name:STUART SCHNELLER
Entity Type:Organization
Organization Name:STUART SCHNELLER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:SCHNELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-787-5111
Mailing Address - Street 1:736 CAMBRIDGE ST
Mailing Address - Street 2:CCP-9
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2907
Mailing Address - Country:US
Mailing Address - Phone:617-787-5111
Mailing Address - Fax:617-787-5150
Practice Address - Street 1:736 CAMBRIDGE ST
Practice Address - Street 2:CCP-9
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:617-787-5111
Practice Address - Fax:617-787-5150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA41617174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0103527Medicaid
MAE05200Medicare PIN
MA0103527Medicaid