Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 185627 | NY |
NPI | 1023054350 |
---|---|
Provider Name | Dr. Gideon Schneck |
First Address | Stony Brook, NY 11790-0989 |
Second Address | East Setauket, NY 11733-3489 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01256940 | (05) | NY |
4347288 | AETNA (01) | NY |
E56120 | (02) | NY |