Provider Demographics
NPI:1962686113
Name:SCHATT, BRUCE T (COTA)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:T
Last Name:SCHATT
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 OLD NORTHERN BLVD
Mailing Address - Street 2:ROSLYN
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2146
Mailing Address - Country:US
Mailing Address - Phone:516-625-6846
Mailing Address - Fax:516-632-1152
Practice Address - Street 1:156-11 65TH AVENUE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-5678
Practice Address - Country:US
Practice Address - Phone:718-735-9303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001621-1247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5678Medicare UPIN