Healthcare Provider Details

I. General information

NPI: 1912909490
Provider Name (Legal Business Name): TODD R SCHLIFSTEIN D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E 69TH ST SUITE 2C
NEW YORK NY
10021-5471
US

IV. Provider business mailing address

201 E 69TH ST SUITE 2C
NEW YORK NY
10021-5471
US

V. Phone/Fax

Practice location:
  • Phone: 212-327-1316
  • Fax: 212-327-1613
Mailing address:
  • Phone: 212-327-1316
  • Fax: 212-327-1613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number205272
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: