Provider Demographics
NPI:1629046321
Name:SCHNEIDER, KENNETH LESLIE (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:LESLIE
Last Name:SCHNEIDER
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 1:530 FIRST AVE
Mailing Address - Street 2:SUITE 3C
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-263-7165
Mailing Address - Fax:212-263-8490
Practice Address - Street 1:530 FIRST AVE
Practice Address - Street 2:SUITE 3C
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-263-7165
Practice Address - Fax:212-263-8490
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141216207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01D881OtherBC/BS
C04488Medicare UPIN