Provider Demographics
NPI:1366798381
Name:JEFFREY SCHNELLER DPM PC
Entity type:Organization
Organization Name:JEFFREY SCHNELLER DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SCHNELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM, PC
Authorized Official - Phone:718-672-8266
Mailing Address - Street 1:4555 43RD ST
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-2609
Mailing Address - Country:US
Mailing Address - Phone:718-729-1952
Mailing Address - Fax:718-706-0170
Practice Address - Street 1:4555 43RD ST
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-2609
Practice Address - Country:US
Practice Address - Phone:718-729-1952
Practice Address - Fax:718-706-0170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004139-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00966610Medicaid