Healthcare Provider Details

I. General information

NPI: 1194384743
Provider Name (Legal Business Name): ELI SCHNECK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

297 NORTH ST STE 221
HYANNIS MA
02601-5133
US

IV. Provider business mailing address

240 E SILVERADO RANCH BLVD UNIT 2091
LAS VEGAS NV
89183-3466
US

V. Phone/Fax

Practice location:
  • Phone: 508-862-5378
  • Fax:
Mailing address:
  • Phone: 847-687-5612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1025636
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number1025636
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: