Provider Demographics
NPI:1821230798
Name:SCHILDHORN, JEFFREY CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CHARLES
Last Name:SCHILDHORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 E 61ST ST APT 6HS
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-0382
Mailing Address - Country:US
Mailing Address - Phone:212-980-1375
Mailing Address - Fax:
Practice Address - Street 1:521 PARK AVE
Practice Address - Street 2:#1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8140
Practice Address - Country:US
Practice Address - Phone:212-980-1375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA116971207X00000X
MA237518207X00000X
NY266262207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0071970Medicaid
CAGR0071970Medicaid
NYA400081857Medicare PIN