Provider Demographics
NPI:1942346432
Name:SCHMOLL, TODD C (DO)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:C
Last Name:SCHMOLL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08008-2653
Mailing Address - Country:US
Mailing Address - Phone:609-492-0900
Mailing Address - Fax:609-492-1347
Practice Address - Street 1:3003 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08008-2653
Practice Address - Country:US
Practice Address - Phone:609-492-0900
Practice Address - Fax:609-492-1347
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05973500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG08902Medicare UPIN
NJ784398MAOMedicare PIN