MEDICARE: DR. THOMAS E SCHENK

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	2080A0000X	Pediatric Adolescent Medicine Physician	217528	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00025593701	OTHER	NY	UNIVERA
3	1211228	OTHER	NY	INDEPENDENT HEALTH ASSOC

General Provider Information

NPI Number	:	1235115957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS E SCHENK

Provider Business Mailing Address
First Line	:	1131 DELAWARE AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14209-1603
Country	:	US
Telephone Number	:	716-884-0230
Fax Number	:	716-884-2415

Provider Business Practice Location Address
First Line	:	1131 DELAWARE AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14209-1603
Country	:	US
Telephone Number	:	716-884-0230
Fax Number	:	716-884-2415

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	07/08/2007

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