Provider Demographics
NPI:1245773100
Name:JEFFREY CHARLES SCHILDHORN MD PLLC
Entity type:Organization
Organization Name:JEFFREY CHARLES SCHILDHORN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SCHILDHORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-706-8008
Mailing Address - Street 1:521 PARK AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8140
Mailing Address - Country:US
Mailing Address - Phone:845-706-8008
Mailing Address - Fax:
Practice Address - Street 1:521 PARK AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8140
Practice Address - Country:US
Practice Address - Phone:845-706-8008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266262174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty