Healthcare Provider Details

I. General information

NPI: 1386554699
Provider Name (Legal Business Name): MAXIM DE SCHEPPER MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

1376 YORK AVE APT 4C
NEW YORK NY
10021-3427
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-5337
  • Fax:
Mailing address:
  • Phone: 646-623-1905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberP141316
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: