Provider Demographics
NPI:1194327262
Name:SCHOTTENFELD, JEFFREY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:SCHOTTENFELD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CHESTNUT LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-1912
Mailing Address - Country:US
Mailing Address - Phone:516-680-8294
Mailing Address - Fax:
Practice Address - Street 1:415 CROSSWAYS PARK DR STE B
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2055
Practice Address - Country:US
Practice Address - Phone:516-249-7436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066926183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist