Provider Demographics
NPI:1750455663
Name:BRIAN J. SCHULTZ, D.P.M., PC
Entity Type:Organization
Organization Name:BRIAN J. SCHULTZ, D.P.M., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:212-725-9090
Mailing Address - Street 1:161 MADISON AVE
Mailing Address - Street 2:SUITE 9NE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5421
Mailing Address - Country:US
Mailing Address - Phone:212-725-9090
Mailing Address - Fax:212-725-1040
Practice Address - Street 1:161 MADISON AVE
Practice Address - Street 2:SUITE 9NE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5421
Practice Address - Country:US
Practice Address - Phone:212-725-9090
Practice Address - Fax:212-725-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005054213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01518643Medicaid
NYP669749OtherOXFORD HEALTH PLAN
NY0137670OtherGHI
NY5C7825OtherHEALTH NET
NYPPWX11Medicare PIN
NY5C7825OtherHEALTH NET