Provider Demographics
NPI:1811020043
Name:SCHNEIDERMAN, GARY SEYMOUR (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:SEYMOUR
Last Name:SCHNEIDERMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6436
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-0436
Mailing Address - Country:US
Mailing Address - Phone:201-653-7886
Mailing Address - Fax:201-653-2266
Practice Address - Street 1:895 BERGEN AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4309
Practice Address - Country:US
Practice Address - Phone:201-653-7886
Practice Address - Fax:201-653-2266
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ163531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2094801Medicaid
NJ223072863OtherEMPLOYER ID NUMBER