Provider Demographics
NPI:1851493217
Name:SCHULLER, ALAN M (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:M
Last Name:SCHULLER
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 1:200 W CARVER ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3303
Mailing Address - Country:US
Mailing Address - Phone:631-421-0020
Mailing Address - Fax:631-421-5991
Practice Address - Street 1:200 W CARVER ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:631-421-0020
Practice Address - Fax:531-421-4138
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168753207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AS026F8210OtherBCBS
064OtherNY MEDCAID SPECIALTY CODE
OC8780OtherHEALTHNET
110106899OtherRAILROAD MEDICARE
4231280OtherAETNA
SA8753OtherATLANTIS
1866720001OtherCIGNA
3006OtherNEIC SITE ID, NSF BA0-7
112234962OtherTAX ID
1687532OtherWC/NF
E44640OtherUNIVERSAL PERSON IDENTIFI
003OtherNY MEDCAID PROV/SRV CNTR
168753OtherMEDICAL LICENSE #
394390OtherCONNECTICARE
01144274OtherMEDCAID ID
NY01144274Medicaid
3006OtherNEIC SITE ID, NSF BA0-7
E44640OtherUNIVERSAL PERSON IDENTIFI