Provider Demographics
NPI:1710989470
Name:SCHILLER, JEFFREY DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DAVID
Last Name:SCHILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1550 RICHMOND AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1578
Mailing Address - Country:US
Mailing Address - Phone:718-370-1001
Mailing Address - Fax:718-370-0945
Practice Address - Street 1:1550 RICHMOND AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1578
Practice Address - Country:US
Practice Address - Phone:718-370-1001
Practice Address - Fax:718-370-0945
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145786207W00000X, 207WX0200X
NJAS9339587207W00000X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01338967Medicaid
NJ3785904Medicaid
NJ184652Medicare PIN
NYC53782Medicare UPIN
NJ3785904Medicaid