Provider Demographics
NPI:1871753186
Name:SCHAEFER, ELAINE MARGARET (DO)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARGARET
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-3450
Mailing Address - Country:US
Mailing Address - Phone:631-581-4481
Mailing Address - Fax:631-581-4562
Practice Address - Street 1:260 MAIN ST
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3450
Practice Address - Country:US
Practice Address - Phone:631-581-4481
Practice Address - Fax:631-581-4562
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250896207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine