Healthcare Provider Details

I. General information

NPI: 1164694394
Provider Name (Legal Business Name): RONALD SCHENENDORF MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 08/24/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 HILO DRIVE
SHELTER ISLAND NY
11964-1588
US

IV. Provider business mailing address

PO BOX 1588C
SHELTER ISLAND NY
11964-1588
US

V. Phone/Fax

Practice location:
  • Phone: 516-627-2726
  • Fax: 516-750-9085
Mailing address:
  • Phone: 516-627-2726
  • Fax: 516-750-9085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number131649
License Number StateNY

VIII. Authorized Official

Name: RONALD SCHENENDORF
Title or Position: PRESIDENT
Credential: MD
Phone: 516-627-2726