MEDICARE: EVERETT SCHLAM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	25MA05066100	NJ

General Provider Information

NPI Number	:	1033183629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVERETT SCHLAM MD

Provider Business Mailing Address
First Line	:	PO BOX 23831
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07189-0001
Country	:	US
Telephone Number	:	973-971-5595
Fax Number	:

Provider Business Practice Location Address
First Line	:	799 BLOOMFIELD AVE
Second Line	:
City	:	VERONA
State	:	NJ
Zip	:	07044-1367
Country	:	US
Telephone Number	:	973-971-5595
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	07/08/2007

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