Basic Information
Provider Information | |||||||||
NPI: | 1689791329 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SCHUYLER | ||||||||
FirstName: | ERICA | ||||||||
MiddleName: | ANN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 40,000 DEPT 634 | ||||||||
Address2: | HARTFORD HOSPITAL PROFESSIONAL SERVICES | ||||||||
City: | HARTFORD | ||||||||
State: | CT | ||||||||
PostalCode: | 061510634 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8605457602 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 80 SEYMOUR STREET | ||||||||
Address2: | HARTFORD HOSPITAL NEUROLOGY DEPT | ||||||||
City: | HARTFORD | ||||||||
State: | CT | ||||||||
PostalCode: | 061025037 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8605453621 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/26/2007 | ||||||||
LastUpdateDate: | 10/20/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 047700 | CT | Y |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0600X | 047700 | CT | N |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Clinical Neurophysiology | 390200000X | 4301083078 | MI | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   |
ID Information
ID | Type | State | Issuer | Description | 001477009 | 05 | CT |   | MEDICAID |