=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275863292
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY B SCHOENGOLD D.D.S
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2010
-----------------------------------------------------
Last Update Date | 01/14/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 435 NORTH STREET 1
-----------------------------------------------------
City | WHITE PLAINS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10605-2230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-328-0071
-----------------------------------------------------
Fax | 914-358-1326
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 435 NORTH ST JEFFREY B.SCHOENGOLD DDS
-----------------------------------------------------
City | WHITE PLAINS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-328-0071
-----------------------------------------------------
Fax | 914-358-1326
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 036245
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------