Provider Demographics
NPI:1801275078
Name:SCHOENEMAN, BROGAN
Entity type:Individual
Prefix:
First Name:BROGAN
Middle Name:
Last Name:SCHOENEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1198
Mailing Address - Country:US
Mailing Address - Phone:585-924-0690
Mailing Address - Fax:585-924-2402
Practice Address - Street 1:53 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1198
Practice Address - Country:US
Practice Address - Phone:585-924-0690
Practice Address - Fax:585-924-2402
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292567207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine