Healthcare Provider Details

I. General information

NPI: 1528065984
Provider Name (Legal Business Name): JONATHAN SCOT SCHREIBER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNARD LANE SUITE 102
BLOOMFIELD CT
06002
US

IV. Provider business mailing address

1 BARNARD LANE SUITE 102
BLOOMFIELD CT
06002
US

V. Phone/Fax

Practice location:
  • Phone: 860-243-1889
  • Fax: 860-243-5733
Mailing address:
  • Phone: 860-243-1889
  • Fax: 860-243-5733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number034529
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: