Basic Information
Provider Information
NPI: 1265739882
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHILLER
FirstName: MONICA
MiddleName: G
NamePrefix: MS.
NameSuffix:  
Credential: PA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 177 FORT WASHINGTON AVE RM 8-004
Address2: ROOM 8-004
City: NEW YORK
State: NY
PostalCode: 100323733
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 177 FORT WASHINGTON AVE
Address2: ROOM 8-004
City: NEW YORK
State: NY
PostalCode: 100323733
CountryCode: US
TelephoneNumber: 2123055138
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/16/2011
LastUpdateDate: 02/16/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700X014551-1NYY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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