Healthcare Provider Details

I. General information

NPI: 1972500858
Provider Name (Legal Business Name): JACQUES M. SCHMID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 COMMACK RD
COMMACK NY
11725-6021
US

IV. Provider business mailing address

283 COMMACK RD
COMMACK NY
11725-6021
US

V. Phone/Fax

Practice location:
  • Phone: 631-499-2226
  • Fax: 631-499-1419
Mailing address:
  • Phone: 631-499-2226
  • Fax: 631-499-1419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number131333
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: