MEDICARE: DR. MARK SCHOENBERG M.D.

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	2084P0800X	Psychiatry Physician	109058	NY

General Provider Information

NPI Number	:	1861435372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK SCHOENBERG M.D.

Provider Business Mailing Address
First Line	:	1239 NORTH COUNTRY ROAD
Second Line	:	SUITE 7
City	:	STONY BROOK
State	:	NY
Zip	:	11790
Country	:	US
Telephone Number	:	631-928-5245
Fax Number	:	631-941-2774

Provider Business Practice Location Address
First Line	:	1239 NORTH COUNTRY ROAD
Second Line	:	SUITE 7
City	:	STONY BROOK
State	:	NY
Zip	:	11790
Country	:	US
Telephone Number	:	631-751-2350
Fax Number	:	631-941-2774

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	03/14/2014

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