=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134458748
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STUART SCHNELLER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2009
-----------------------------------------------------
Last Update Date | 12/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 736 CAMBRIDGE ST CCP-9
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02135-2907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-787-5111
-----------------------------------------------------
Fax | 617-787-5150
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 736 CAMBRIDGE ST CCP-9
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02135-2907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-787-5111
-----------------------------------------------------
Fax | 617-787-5150
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE PROPRIETOR
-----------------------------------------------------
Name | DR. STUART JOEL SCHNELLER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 617-787-5111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 41617
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------