1457394082 NPI number — DR. CONSTANCE ELLEN SCHOENBERG PH.D.

Table of content: ELIZABETH STEWART (NPI 1083297386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457394082 NPI number — DR. CONSTANCE ELLEN SCHOENBERG PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHOENBERG
Provider First Name:
CONSTANCE
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

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:
1457394082
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 E BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT JEFFERSON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11777-1248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-928-5245
Provider Business Mailing Address Fax Number:
631-941-2774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1239 N COUNTRY RD
Provider Second Line Business Practice Location Address:
STE 7
Provider Business Practice Location Address City Name:
STONY BROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11790-1934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-751-4615
Provider Business Practice Location Address Fax Number:
631-941-2774
Provider Enumeration Date:
06/13/2006

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: 103TC0700X , with the licence number:  011324 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: S11324 . This is a "WORKER'S COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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