=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336774512
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHILIP SCHATZ DPM PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2020
-----------------------------------------------------
Last Update Date | 05/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2391 BELL BLVD STE 205
-----------------------------------------------------
City | BAYSIDE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11360-2019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-703-3369
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3903 BEECHWOOD PL
-----------------------------------------------------
City | SEAFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11783-2023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-510-7333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | DR. PHILIP SCHATZ
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 718-510-7333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------