Healthcare Provider Details

I. General information

NPI: 1467629212
Provider Name (Legal Business Name): MRS. BETH A SCHMITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 MONTAUK HWY 2
OAKDALE NY
11769-1434
US

IV. Provider business mailing address

35 ZAVRA ST
BOHEMIA NY
11716-1713
US

V. Phone/Fax

Practice location:
  • Phone: 631-218-1545
  • Fax:
Mailing address:
  • Phone: 631-244-9383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number011647-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: