=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114968286
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAY S SCHACHNE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2006
-----------------------------------------------------
Last Update Date | 04/27/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1800 MAIN RD
-----------------------------------------------------
City | TIVERTON
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02878-4625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-973-9700
-----------------------------------------------------
Fax | 508-674-7378
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 MILL RD SUITE 180
-----------------------------------------------------
City | FAIRHAVEN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02719-5252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-973-2000
-----------------------------------------------------
Fax | 508-973-2001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 54312
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | MD06705
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------