Provider Demographics
NPI:1760733570
Name:SCHIMMEL ORTHODONTIC ASSOCIATES
Entity Type:Organization
Organization Name:SCHIMMEL ORTHODONTIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHIMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-548-4768
Mailing Address - Street 1:3265 JOHNSON AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3539
Mailing Address - Country:US
Mailing Address - Phone:718-548-4768
Mailing Address - Fax:718-543-0594
Practice Address - Street 1:3265 JOHNSON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3539
Practice Address - Country:US
Practice Address - Phone:718-548-4768
Practice Address - Fax:718-543-0594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241841223X0400X
NY0502861223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02768963Medicaid
NY02139119Medicaid