Basic Information
Provider Information | |||||||||
NPI: | 1598723124 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SCHIFF | ||||||||
FirstName: | STEPHEN | ||||||||
MiddleName: | FRANK | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 320 POMFRET ST | ||||||||
Address2: | CSB 2 | ||||||||
City: | PUTNAM | ||||||||
State: | CT | ||||||||
PostalCode: | 062601836 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8609286541 | ||||||||
FaxNumber: | 8609636450 | ||||||||
Practice Location | |||||||||
Address1: | 320 POMFRET ST | ||||||||
Address2: | CSB 2 | ||||||||
City: | PUTNAM | ||||||||
State: | CT | ||||||||
PostalCode: | 062601836 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8609286541 | ||||||||
FaxNumber: | 8609636450 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/03/2006 | ||||||||
LastUpdateDate: | 01/16/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 28705 | CT | Y |   | Allopathic & Osteopathic Physicians | Urology |   | 208800000X | RI8242 | RI | N |   | Allopathic & Osteopathic Physicians | Urology |   |
ID Information
ID | Type | State | Issuer | Description | 0004125228 | 01 | RI | AETNA | OTHER | 1900147 | 01 | RI | UNITED HEALTH CARE | OTHER | 10058 | 01 | RI | NEIGHBORHOOD HEALTH PLAN | OTHER | D400506349 | 01 | CT | MEDICARE | OTHER | 001287053 | 05 | CT |   | MEDICAID | 008242 | 01 | RI | TIFTS | OTHER | 202809 | 01 | RI | BLUE CHIP | OTHER | 27180 | 01 | RI | HARVARD PILGRIM HEALTH CA | OTHER | 25692 | 01 | RI | BLUE CROSS BLUE SHIELD RH | OTHER |