Healthcare Provider Details

I. General information

NPI: 1578666384
Provider Name (Legal Business Name): ROGER SCHENONE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MADISON AVE
ELMIRA NY
14901-3218
US

IV. Provider business mailing address

600 ROE AVE
ELMIRA NY
14905-1629
US

V. Phone/Fax

Practice location:
  • Phone: 607-734-1581
  • Fax: 607-767-4137
Mailing address:
  • Phone: 607-737-7732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number158529
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: