Provider Demographics
NPI:1548284664
Name:SCHNEIDER, ABRAHAM T (MD)
Entity type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:T
Last Name:SCHNEIDER
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 1:1630 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-5210
Mailing Address - Country:US
Mailing Address - Phone:631-242-6166
Mailing Address - Fax:631-242-8768
Practice Address - Street 1:1630 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-5210
Practice Address - Country:US
Practice Address - Phone:631-242-6166
Practice Address - Fax:631-242-8768
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY177182207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01465416Medicaid
NY01465416Medicaid
NYF14567Medicare UPIN