Healthcare Provider Details

I. General information

NPI: 1063018109
Provider Name (Legal Business Name): CARRIE ELLEN SCHROEDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 W ALLENDALE AVE STE 4
ALLENDALE NJ
07401-1755
US

IV. Provider business mailing address

109 YESLER WAY
HILLSDALE NJ
07642-2612
US

V. Phone/Fax

Practice location:
  • Phone: 201-340-6052
  • Fax:
Mailing address:
  • Phone: 201-362-8718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: