Healthcare Provider Details

I. General information

NPI: 1427027671
Provider Name (Legal Business Name): ELLEN BETH SCHAEFFER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5229 WITZ DRIVE
NORTH SYRACUSE NY
13212
US

IV. Provider business mailing address

5229 WITZ DRIVE
NORTH SYRACUSE NY
13212
US

V. Phone/Fax

Practice location:
  • Phone: 315-701-9500
  • Fax:
Mailing address:
  • Phone: 315-701-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number193202
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: