Provider Demographics
NPI:1851337331
Name:J DAVID SCHAEFER MD PLLC
Entity Type:Organization
Organization Name:J DAVID SCHAEFER MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-393-7955
Mailing Address - Street 1:3 LYON PLACE
Mailing Address - Street 2:STE 200
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669
Mailing Address - Country:US
Mailing Address - Phone:315-393-7955
Mailing Address - Fax:315-393-7927
Practice Address - Street 1:3 LYON PLACE
Practice Address - Street 2:STE 302
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669
Practice Address - Country:US
Practice Address - Phone:315-393-7955
Practice Address - Fax:315-393-7927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230224-1207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02524436Medicaid
NYRA1573Medicare ID - Type Unspecified
NYF37441Medicare UPIN
BA0145Medicare PIN