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General NPI Number Information
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NPI Number | 1700942950
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Entity Type | Organization
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Legal Business Name | KENNETH L SCHOEN PC
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 12/09/2013
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Provider Practice Location Address
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Address Line | 710 FOREST AVE FOREST PROFESSIONAL ARTS BLDG
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City | STATEN ISLAND
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State | NY
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Zip | 10310
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Country | US
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Telephone | 718-442-2065
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Fax |
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Provider Business Mailing Address
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Address Line | 710 FOREST AVE FOREST PROFESSIONAL ARTS BLDG
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City | STATEN ISLAND
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State | NY
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Zip | 10310
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Country | US
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Telephone | 718-442-2065
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH L SCHOEN
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Credential | MD
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Telephone | 718-442-2065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 111572MD
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License Number State | NY
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