Provider Demographics
NPI:1780998682
Name:SCHUBERT LARTIGUE PHYSICIAN LLC
Entity type:Organization
Organization Name:SCHUBERT LARTIGUE PHYSICIAN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARTIGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-429-7400
Mailing Address - Street 1:34 N ROUTE 9W
Mailing Address - Street 2:
Mailing Address - City:WEST HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10993-1103
Mailing Address - Country:US
Mailing Address - Phone:845-429-7400
Mailing Address - Fax:845-429-5725
Practice Address - Street 1:34 N ROUTE 9W
Practice Address - Street 2:
Practice Address - City:WEST HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10993-1103
Practice Address - Country:US
Practice Address - Phone:845-429-7400
Practice Address - Fax:845-429-5725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206087174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02041147Medicaid
NY02041147Medicaid
NY12V881Medicare PIN