MEDICARE: DR. MARC IRA SCHILLER D.D.S.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	036819	NY
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	22DI01368400	NJ
3	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DS027104L	PA

General Provider Information

NPI Number	:	1841397544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC IRA SCHILLER D.D.S.

Provider Business Mailing Address
First Line	:	4 RENAULT DR
Second Line	:
City	:	PARSIPPANY
State	:	NJ
Zip	:	07054-4034
Country	:	US
Telephone Number	:	973-884-0180
Fax Number	:

Provider Business Practice Location Address
First Line	:	7815 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-3703
Country	:	US
Telephone Number	:	718-745-4422
Fax Number	:

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

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	07/08/2007

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