Provider Demographics
NPI:1558544767
Name:GLEN SCHNEIDER DPM PA
Entity Type:Organization
Organization Name:GLEN SCHNEIDER DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-487-3500
Mailing Address - Street 1:9080 KIMBERLY BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-2862
Mailing Address - Country:US
Mailing Address - Phone:561-487-3500
Mailing Address - Fax:561-487-5994
Practice Address - Street 1:9080 KIMBERLY BLVD STE 5
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-2862
Practice Address - Country:US
Practice Address - Phone:561-487-3500
Practice Address - Fax:561-487-5994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2857213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340249500Medicaid
FLU90493Medicare UPIN
FL340249500Medicaid
FL4685330001Medicare NSC
FLAI018Medicare PIN