Healthcare Provider Details

I. General information

NPI: 1194178947
Provider Name (Legal Business Name): BETH TAMI SCHOEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 ROUTE 32
CENTRAL VALLEY NY
10917
US

IV. Provider business mailing address

PO BOX 489
HIGHLAND MILLS NY
10930-0489
US

V. Phone/Fax

Practice location:
  • Phone: 845-827-6364
  • Fax:
Mailing address:
  • Phone: 845-827-6364
  • Fax: 845-827-5496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number239905031
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: