Healthcare Provider Details

I. General information

NPI: 1780617076
Provider Name (Legal Business Name): DOUGLAS C SCHOTTENSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 E 48TH ST SUITE 901
NEW YORK NY
10017-1014
US

IV. Provider business mailing address

18 E 48TH ST SUITE 901
NEW YORK NY
10017-1014
US

V. Phone/Fax

Practice location:
  • Phone: 212-750-1155
  • Fax: 212-750-1170
Mailing address:
  • Phone: 212-750-1155
  • Fax: 212-750-1170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number232232-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: