Healthcare Provider Details

I. General information

NPI: 1386298693
Provider Name (Legal Business Name): EDO SCHAEFER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 09/03/2022
Certification Date: 09/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE
HAWTHORNE NY
10532-2140
US

IV. Provider business mailing address

19 SKYLINE DR
HAWTHORNE NY
10532-2134
US

V. Phone/Fax

Practice location:
  • Phone: 914-909-5361
  • Fax: 914-909-5364
Mailing address:
  • Phone: 914-493-7997
  • Fax: 914-909-5364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number318098
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: