Healthcare Provider Details

I. General information

NPI: 1710169578
Provider Name (Legal Business Name): MICHAEL SCHLOSS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304A E 30TH ST
NEW YORK NY
10016-8303
US

IV. Provider business mailing address

304A E 30TH ST
NEW YORK NY
10016-8303
US

V. Phone/Fax

Practice location:
  • Phone: 212-213-2900
  • Fax: 212-696-9388
Mailing address:
  • Phone: 212-213-2900
  • Fax: 212-696-9388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF302926
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number112610
License Number StateNY

VIII. Authorized Official

Name: DR. MICHAEL F SCHLOSS
Title or Position: PRESIDENT
Credential: MD
Phone: 212-213-2900