Healthcare Provider Details

I. General information

NPI: 1316948763
Provider Name (Legal Business Name): ERIC H. SCHULTHEIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 MANETTO HILL RD SUITE 120
PLAINVIEW NY
11803-1324
US

IV. Provider business mailing address

146 MANETTO HILL RD SUITE 120
PLAINVIEW NY
11803-1324
US

V. Phone/Fax

Practice location:
  • Phone: 516-931-2200
  • Fax: 516-931-4047
Mailing address:
  • Phone: 516-931-2200
  • Fax: 516-931-4047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number180431
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: