1962580910 NPI number — DR. CHARLES MARTIN SCHULTZ MD

Table of content: DR. CHARLES MARTIN SCHULTZ MD (NPI 1962580910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962580910 NPI number — DR. CHARLES MARTIN SCHULTZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHULTZ
Provider First Name:
CHARLES
Provider Middle Name:
MARTIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962580910
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
560 WHITE PLAINS ROAD
Provider Second Line Business Mailing Address:
SUITE 500 - ENTA
Provider Business Mailing Address City Name:
TARRTYTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10591-5112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-333-5800
Provider Business Mailing Address Fax Number:
914-333-2544

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3219 ROUTE 46
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
PARSIPPANY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07054-1278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-394-1818
Provider Business Practice Location Address Fax Number:
973-394-1810
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  25MA02687600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 25MA02687600 . This is a "LICENSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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