Provider Demographics
NPI:1861645400
Name:SCHRADER, RALPH WILHELM (OTR/L)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:WILHELM
Last Name:SCHRADER
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8825 195TH PL
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2028
Mailing Address - Country:US
Mailing Address - Phone:917-969-1004
Mailing Address - Fax:
Practice Address - Street 1:8825 195TH PL
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2028
Practice Address - Country:US
Practice Address - Phone:917-969-1004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009893-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor