Healthcare Provider Details

I. General information

NPI: 1407828924
Provider Name (Legal Business Name): JEFFREY SCHNELLER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4902 QUEENS BLVD
WOODSIDE NY
11377-4444
US

IV. Provider business mailing address

402 MIDDLE CREEK RD
HONESDALE PA
18431-7623
US

V. Phone/Fax

Practice location:
  • Phone: 718-729-1952
  • Fax: 718-706-0170
Mailing address:
  • Phone: 516-398-9413
  • Fax: 718-706-0170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberNOO4139-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: