1649087982 NPI number — MATTHEW SCHNIEDERS

Table of content: MATTHEW SCHNIEDERS (NPI 1649087982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649087982 NPI number — MATTHEW SCHNIEDERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHNIEDERS
Provider First Name:
MATTHEW
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1649087982
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 CALLE MONACO C-29
Provider Second Line Business Mailing Address:
VILLA DEL REY 3RA SECCION
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-339-3135
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERA 172 URB. TURABO GARDENS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-743-3038
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/11/2024

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: 390200000X , with the licence number:  SC5940982 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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