Provider Demographics
NPI: | 1245773100 |
---|---|
Name: | JEFFREY CHARLES SCHILDHORN MD PLLC |
Entity Type: | Organization |
Organization Name: | JEFFREY CHARLES SCHILDHORN MD PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JEFFREY |
Authorized Official - Middle Name: | CHARLES |
Authorized Official - Last Name: | SCHILDHORN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 845-706-8008 |
Mailing Address - Street 1: | 521 PARK AVE |
Mailing Address - Street 2: | SUITE 1 |
Mailing Address - City: | NEW YORK |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10065-8140 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 845-706-8008 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 521 PARK AVE |
Practice Address - Street 2: | SUITE 1 |
Practice Address - City: | NEW YORK |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10065-8140 |
Practice Address - Country: | US |
Practice Address - Phone: | 845-706-8008 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-11-28 |
Last Update Date: | 2016-11-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 266262 | 174400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 174400000X | Other Service Providers | Specialist | Group - Single Specialty |