Provider Demographics
NPI:1801453303
Name:SCHAFER, PHILIPPE S (DPT)
Entity type:Individual
Prefix:
First Name:PHILIPPE
Middle Name:S
Last Name:SCHAFER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4543 21ST ST
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5219
Mailing Address - Country:US
Mailing Address - Phone:347-589-8100
Mailing Address - Fax:
Practice Address - Street 1:4543 21ST ST
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5219
Practice Address - Country:US
Practice Address - Phone:347-589-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD225100000X
NY049600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD14469776OtherCAQH
MD14469776OtherCAQH