Provider Demographics
NPI:1285668160
Name:SCHULMAN, STACEY BETH (RD)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:BETH
Last Name:SCHULMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:BETH
Other - Last Name:FREIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:200 E 72ND ST
Mailing Address - Street 2:APT. 21M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4537
Mailing Address - Country:US
Mailing Address - Phone:212-600-1268
Mailing Address - Fax:
Practice Address - Street 1:119 W 57TH ST
Practice Address - Street 2:SUITE 1414
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2303
Practice Address - Country:US
Practice Address - Phone:212-333-4243
Practice Address - Fax:212-333-3468
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005478133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005478OtherHIP
NYFS5478OtherHUMANA
NE7290768OtherUSHC
NY2583421OtherHORIZON
NY0104538OtherGHI
NY1G1321OtherBLUECROSS
NYP3647844OtherOXFORD
NY1116149OtherWELLCARE
NY9110723002OtherCIGNA