Healthcare Provider Details

I. General information

NPI: 1710911086
Provider Name (Legal Business Name): KENNETH B SCHNIDE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7385 S BROADWAY
RED HOOK NY
12571-1745
US

IV. Provider business mailing address

7385 S BROADWAY
RED HOOK NY
12571-1745
US

V. Phone/Fax

Practice location:
  • Phone: 845-758-9118
  • Fax: 845-758-2340
Mailing address:
  • Phone: 845-758-9118
  • Fax: 845-758-2340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number155162
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: