MEDICARE: LAURA GRAY SCHOENBERG, D.O., P.C

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	204R00000X	Electrodiagnostic Medicine Physician
2	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician
3	2084A2900X	Neurocritical Care Physician
4	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician
5	204D00000X	Neuromusculoskeletal Medicine & OMM Physician
6	2084N0008X	Neuromuscular Medicine (Psychiatry & Neurology) Physician
7	2084N0600X	Clinical Neurophysiology Physician
8	2084P0005X	Neurodevelopmental Disabilities Physician
9	2084P0015X	Psychosomatic Medicine Physician
10	2084V0102X	Vascular Neurology Physician
11	2084P0301X	Brain Injury Medicine (Psychiatry & Neurology) Physician
12	2084S0010X	Sports Medicine (Psychiatry & Neurology) Physician
13	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician
14	2084N0400X	Neurology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00S241	OTHER	NY	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568605574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAURA GRAY SCHOENBERG, D.O., P.C

Provider Business Mailing Address
First Line	:	PO BOX 292
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-0292
Country	:	US
Telephone Number	:	516-358-1444
Fax Number	:	516-358-2390

Provider Business Practice Location Address
First Line	:	2037 JERICHO TPKE
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-4720
Country	:	US
Telephone Number	:	516-358-1444
Fax Number	:	516-358-2390

Authorized Official
Title or Position	:	MANAGER
Name	:	DIANA SCHOEBERG
Credential	:	BS
Telephone Number	:	516-358-1444

Provider Enumeration Date	:	04/07/2009
Last Update Date	:	10/04/2019

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