Provider Demographics
NPI:1942207261
Name:SNEIDER, JEFFREY S (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:SNEIDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JEF
Other - Middle Name:
Other - Last Name:SNEIDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:215 DEWITT RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-2006
Mailing Address - Country:US
Mailing Address - Phone:315-256-5658
Mailing Address - Fax:
Practice Address - Street 1:215 DEWITT RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13214-2006
Practice Address - Country:US
Practice Address - Phone:315-256-5658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126121207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY126121OtherLICENSE #
NY0066-3974Medicaid
53979BMedicare ID - Type Unspecified
NY51138DMedicare ID - Type UnspecifiedST. JOSEPH'S EKG, LLP
NY0066-3974Medicaid