Provider Demographics
NPI:1346583515
Name:SCHENENDORF, JESSE NATHANIEL (MD)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:NATHANIEL
Last Name:SCHENENDORF
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 1:2300 W JEFFERSON RD STE 400
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-1090
Mailing Address - Country:US
Mailing Address - Phone:585-427-9950
Mailing Address - Fax:585-424-2788
Practice Address - Street 1:2300 W JEFFERSON RD STE 400
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1090
Practice Address - Country:US
Practice Address - Phone:585-427-9950
Practice Address - Fax:585-424-2788
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282471363AM0700X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04377299Medicaid
NYJ400303394Medicare PIN