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NPI Code Detail

MEDICARE: MR. TODD RANDALL SCHENK M.ED.

MEDICARE: MR. TODD RANDALL SCHENK M.ED.
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1740365923
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TODD RANDALL SCHENK M.ED.
Provider Business Mailing Address
First Line : 5 SENECA PL
Second Line :
City : UPPER MONTCLAIR
State : NJ
Zip : 07043-1114
Country : US
Telephone Number : 973-744-4353
Fax Number :
Provider Business Practice Location Address
First Line : 2795 RICHMOND AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-5857
Country : US
Telephone Number : 718-761-9800
Fax Number : 718-370-1142
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2006
Last Update Date : 07/08/2007

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