1699835751 NPI number — GLENN SCHROYER, MD PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699835751 NPI number — GLENN SCHROYER, MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLENN SCHROYER, MD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1699835751
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 GLEN DR
Provider Second Line Business Mailing Address:
STE 2
Provider Business Mailing Address City Name:
PLATTSBURGH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12901-2237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-562-2009
Provider Business Mailing Address Fax Number:
518-562-2119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1785 MILITARY TPKE
Provider Second Line Business Practice Location Address:
SUITE 14
Provider Business Practice Location Address City Name:
PLATTSBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12901-7704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-562-2009
Provider Business Practice Location Address Fax Number:
518-562-2119
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHROYER
Authorized Official First Name:
GLENN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
518-562-2009

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  187467 , 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: 02056839 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com