=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306917687
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOUVERNEUR PEDIATRICS,PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2006
-----------------------------------------------------
Last Update Date | 07/31/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 77 W BARNEY ST PHYSICIAN BLDG. STE.C
-----------------------------------------------------
City | GOUVERNEUR
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13642-1040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-287-4440
-----------------------------------------------------
Fax | 315-287-1858
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 77 W BARNEY ST PHYSICIAN BLDG. STE.C
-----------------------------------------------------
City | GOUVERNEUR
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13642-1040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-287-4440
-----------------------------------------------------
Fax | 315-287-1858
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT OF PROF.CORPORATION
-----------------------------------------------------
Name | DR. DONALD C SCHUESSLER JR.
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 315-287-4440
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 156955
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------