Healthcare Provider Details

I. General information

NPI: 1396734570
Provider Name (Legal Business Name): JAY JEFFREY SCHNITZER M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST PEDIATRIC SURGERY, WRN 11
BOSTON MA
02114-2621
US

IV. Provider business mailing address

PO BOX 9142 MASS. GENERAL PHYSICIAN ORGANIZATION
CHARLESTOWN MA
02129-9142
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-1602
  • Fax: 617-726-2167
Mailing address:
  • Phone: 617-724-0287
  • Fax: 617-726-2894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number59597
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number59597
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: