Healthcare Provider Details

I. General information

NPI: 1730190554
Provider Name (Legal Business Name): GEORGE SCHNEIDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 EAGLE ROCK AVE
ROSELAND NJ
07068-1723
US

IV. Provider business mailing address

5 COLUMBIA RD
LIVINGSTON NJ
07039-5503
US

V. Phone/Fax

Practice location:
  • Phone: 973-228-2047
  • Fax: 973-228-1428
Mailing address:
  • Phone: 973-994-0875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number25MA02634400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: