=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720767353
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDASSIST NY CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2023
-----------------------------------------------------
Last Update Date | 07/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 747 CHESTNUT RIDGE RD
-----------------------------------------------------
City | SPRING VALLEY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10977-6224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-541-3223
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 SUTIN PL
-----------------------------------------------------
City | SPRING VALLEY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10977-6424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SHARON SCHNEIDER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-541-3223
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------