Healthcare Provider Details

I. General information

NPI: 1295805406
Provider Name (Legal Business Name): S. KENNETH SCHONBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MMC - DEPT. OF PEDIATRICS 111 EAST 210TH STREET
BRONX NY
10467
US

IV. Provider business mailing address

15 HIDDEN HOLLOW LN
MILLWOOD NY
10546-1008
US

V. Phone/Fax

Practice location:
  • Phone: 718-696-4062
  • Fax:
Mailing address:
  • Phone: 718-696-4062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number097096
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: