Provider Demographics
NPI:1144648080
Name:SCHMALE, ISAAC LAZER (MD)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:LAZER
Last Name:SCHMALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 STATE ST APT 80
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-2170
Mailing Address - Country:US
Mailing Address - Phone:831-359-7745
Mailing Address - Fax:
Practice Address - Street 1:URMC 601 ELMWOOD AVE
Practice Address - Street 2:BOX 629
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-8629
Practice Address - Country:US
Practice Address - Phone:585-276-5181
Practice Address - Fax:585-271-8552
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program