Provider Demographics
NPI:1699303586
Name:SHNEIDER, ALEC (PTA)
Entity type:Individual
Prefix:
First Name:ALEC
Middle Name:
Last Name:SHNEIDER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 H URBAN DR # A2
Mailing Address - Street 2:
Mailing Address - City:CLINTONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12515-5042
Mailing Address - Country:US
Mailing Address - Phone:845-978-1603
Mailing Address - Fax:
Practice Address - Street 1:31 H URBAN DR # A2
Practice Address - Street 2:
Practice Address - City:CLINTONDALE
Practice Address - State:NY
Practice Address - Zip Code:12515-5042
Practice Address - Country:US
Practice Address - Phone:845-978-1603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-28
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006343225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006343Medicaid