Provider Demographics
NPI:1407867211
Name:SCHNEIDERMAN, DAVID JAY (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JAY
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 1:6357 COYLE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0478
Mailing Address - Country:US
Mailing Address - Phone:916-863-1000
Mailing Address - Fax:916-863-1234
Practice Address - Street 1:6357 COYLE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0478
Practice Address - Country:US
Practice Address - Phone:916-863-1000
Practice Address - Fax:916-863-1234
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC407820207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C407820Medicaid
CA00C407820Medicare ID - Type Unspecified
CA00C407820Medicaid