Healthcare Provider Details

I. General information

NPI: 1902820962
Provider Name (Legal Business Name): MARC R. SCHACHTER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

972 ROUTE 45 SUITE 102
POMONA NY
10970-3519
US

IV. Provider business mailing address

972 ROUTE 45 SUITE 102
POMONA NY
10970-3519
US

V. Phone/Fax

Practice location:
  • Phone: 845-354-6900
  • Fax: 845-354-6901
Mailing address:
  • Phone: 845-354-6900
  • Fax: 845-354-6901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number033096
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: