Provider Demographics
NPI:1780664599
Name:SCHORR, ETHLYNN SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ETHLYNN
Middle Name:SUSAN
Last Name:SCHORR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5214
Mailing Address - Country:US
Mailing Address - Phone:201-587-0500
Mailing Address - Fax:201-587-0209
Practice Address - Street 1:4 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5214
Practice Address - Country:US
Practice Address - Phone:201-587-0500
Practice Address - Fax:201-587-0209
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150799207NS0135X
NJ25MA08161800207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E51346Medicare UPIN
63D092Medicare ID - Type Unspecified