Healthcare Provider Details

I. General information

NPI: 1619916244
Provider Name (Legal Business Name): WAYNE SCHNEIDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S SHORE RD SUITE 100
MARMORA NJ
08223-1200
US

IV. Provider business mailing address

210 S SHORE RD SUITE 100
MARMORA NJ
08223-1200
US

V. Phone/Fax

Practice location:
  • Phone: 609-390-0882
  • Fax: 609-390-3511
Mailing address:
  • Phone: 609-390-0882
  • Fax: 609-390-3511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA06303400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: