Healthcare Provider Details

I. General information

NPI: 1053846568
Provider Name (Legal Business Name): COURSEN W SCHNEIDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2017
Last Update Date: 06/13/2025
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 SUMMER ST SUITE 301
STAMFORD CT
06905
US

IV. Provider business mailing address

1275 SUMMER ST SUITE 301
STAMFORD CT
06905
US

V. Phone/Fax

Practice location:
  • Phone: 203-324-4109
  • Fax: 203-969-1271
Mailing address:
  • Phone: 203-324-4109
  • Fax: 203-969-1271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101265792
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number076685
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: