Healthcare Provider Details

I. General information

NPI: 1710989470
Provider Name (Legal Business Name): JEFFREY DAVID SCHILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 RICHMOND AVE SUITE 208
STATEN ISLAND NY
10314-1578
US

IV. Provider business mailing address

1550 RICHMOND AVE SUITE 208
STATEN ISLAND NY
10314-1578
US

V. Phone/Fax

Practice location:
  • Phone: 718-370-1001
  • Fax: 718-370-0945
Mailing address:
  • Phone: 718-370-1001
  • Fax: 718-370-0945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number145786
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberAS9339587
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License NumberAS9339587
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number145786
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: