MEDICARE: ELAINE MARGARET SCHAEFER D.O

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	207Q00000X	Family Medicine Physician	250896	NY

General Provider Information

NPI Number	:	1871753186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELAINE MARGARET SCHAEFER D.O

Provider Business Mailing Address
First Line	:	260 MAIN ST
Second Line	:
City	:	ISLIP
State	:	NY
Zip	:	11751-3450
Country	:	US
Telephone Number	:	631-581-4481
Fax Number	:	631-581-4562

Provider Business Practice Location Address
First Line	:	260 MAIN ST
Second Line	:
City	:	ISLIP
State	:	NY
Zip	:	11751-3450
Country	:	US
Telephone Number	:	631-581-4481
Fax Number	:	631-581-4562

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

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	07/02/2010

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