Healthcare Provider Details

I. General information

NPI: 1134458748
Provider Name (Legal Business Name): STUART SCHNELLER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 CAMBRIDGE ST CCP-9
BRIGHTON MA
02135-2907
US

IV. Provider business mailing address

736 CAMBRIDGE ST CCP-9
BRIGHTON MA
02135-2907
US

V. Phone/Fax

Practice location:
  • Phone: 617-787-5111
  • Fax: 617-787-5150
Mailing address:
  • Phone: 617-787-5111
  • Fax: 617-787-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number41617
License Number StateMA

VIII. Authorized Official

Name: DR. STUART JOEL SCHNELLER
Title or Position: SOLE PROPRIETOR
Credential: M.D.
Phone: 617-787-5111