Provider Demographics
NPI:1295759603
Name:SCHNEIDER, EDWARD KENNETH (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:KENNETH
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 1:2616 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-2753
Mailing Address - Country:US
Mailing Address - Phone:845-297-2100
Mailing Address - Fax:845-297-2903
Practice Address - Street 1:2616 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-2753
Practice Address - Country:US
Practice Address - Phone:845-297-2100
Practice Address - Fax:845-297-2903
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139511-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA60749Medicare UPIN