Provider Demographics
NPI:1184798852
Name:SCHNEIDER, OWEN BENNET (MD)
Entity type:Individual
Prefix:
First Name:OWEN
Middle Name:BENNET
Last Name:SCHNEIDER
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 1:5 SPANISH COVE RD
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-3815
Mailing Address - Country:US
Mailing Address - Phone:914-834-8251
Mailing Address - Fax:914-834-8563
Practice Address - Street 1:5 SPANISH COVE RD
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-3815
Practice Address - Country:US
Practice Address - Phone:914-834-8251
Practice Address - Fax:914-834-8563
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2023-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0320532084P0800X
NY1089612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1320530Medicaid
CT1320530Medicaid
2600001804Medicare ID - Type Unspecified