Provider Demographics
NPI:1972525418
Name:SCHUMANN, MARC S (DPM)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:S
Last Name:SCHUMANN
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 1:260 W SUNRISE HWY
Mailing Address - Street 2:SUITE 111
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-1011
Mailing Address - Country:US
Mailing Address - Phone:516-791-7668
Mailing Address - Fax:516-791-0174
Practice Address - Street 1:260 W SUNRISE HWY
Practice Address - Street 2:SUITE 111
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1011
Practice Address - Country:US
Practice Address - Phone:516-791-7668
Practice Address - Fax:516-791-0174
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004692213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01178954Medicaid
NY01178954Medicaid
U18043Medicare UPIN