Provider Demographics
NPI:1659945186
Name:SCHAEFFER, DAMIAN
Entity Type:Individual
Prefix:
First Name:DAMIAN
Middle Name:
Last Name:SCHAEFFER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1178 BROADWAY # 3255
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1178 BROADWAY # 3255
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5404
Practice Address - Country:US
Practice Address - Phone:212-829-2882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2023-03-06
Deactivation Date:2021-06-28
Deactivation Code:
Reactivation Date:2022-12-15
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program