Healthcare Provider Details

I. General information

NPI: 1265312169
Provider Name (Legal Business Name): ETHAN SCHREIBER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SKYLINE DR
HAWTHORNE NY
10532-2152
US

IV. Provider business mailing address

15 SKYLINE DR
HAWTHORNE NY
10532-2152
US

V. Phone/Fax

Practice location:
  • Phone: 914-347-5990
  • Fax:
Mailing address:
  • Phone: 914-347-5990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number133332
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: