Provider Demographics
NPI:1407828924
Name:SCHNELLER, JEFFREY (DPM)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:SCHNELLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 MIDDLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-7623
Mailing Address - Country:US
Mailing Address - Phone:516-398-9413
Mailing Address - Fax:718-706-0170
Practice Address - Street 1:4902 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4444
Practice Address - Country:US
Practice Address - Phone:718-729-1952
Practice Address - Fax:718-706-0170
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNOO4139-1213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00966610Medicaid
NY00966610Medicaid
480011245Medicare PIN
T51342Medicare UPIN