Healthcare Provider Details

I. General information

NPI: 1992770705
Provider Name (Legal Business Name): ILEANA BERNAL-SCHNATTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 SOUTH AVE
FANWOOD NJ
07023-1364
US

IV. Provider business mailing address

313 SOUTH AVE
FANWOOD NJ
07023-1364
US

V. Phone/Fax

Practice location:
  • Phone: 908-301-2600
  • Fax: 908-301-5456
Mailing address:
  • Phone: 908-301-2600
  • Fax: 908-301-5456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number25MA06257500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: