Healthcare Provider Details

I. General information

NPI: 1386937142
Provider Name (Legal Business Name): JEREMY Z. SCHNALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVENUE PICU
HACKENSACK NJ
07601
US

IV. Provider business mailing address

30 PROSPECT AVENUE PICU
HACKENSACK NJ
07601
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-2403
  • Fax:
Mailing address:
  • Phone: 551-996-2403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number271245
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number262671
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number25MA10378600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: