Provider Demographics
NPI:1710911086
Name:SCHNIDE, KENNETH B (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:B
Last Name:SCHNIDE
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 1:7385 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:RED HOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12571-1745
Mailing Address - Country:US
Mailing Address - Phone:845-758-9118
Mailing Address - Fax:845-758-2340
Practice Address - Street 1:7385 S BROADWAY
Practice Address - Street 2:
Practice Address - City:RED HOOK
Practice Address - State:NY
Practice Address - Zip Code:12571-1745
Practice Address - Country:US
Practice Address - Phone:845-758-9118
Practice Address - Fax:845-758-2340
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00891992Medicaid
NY46D961Medicare ID - Type UnspecifiedEMPIRE
NY00891992Medicaid