Healthcare Provider Details

I. General information

NPI: 1588942353
Provider Name (Legal Business Name): NEIL SCHLACKMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2011
Last Update Date: 07/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 W VILLAGE WAY
JUPITER FL
33458-7821
US

IV. Provider business mailing address

141 W VILLAGE WAY
JUPITER FL
33458-7821
US

V. Phone/Fax

Practice location:
  • Phone: 215-527-8829
  • Fax:
Mailing address:
  • Phone: 215-527-8829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD011021E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberMD011021E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: