Basic Information
| Provider Information | |||||||||
| NPI: | 1770539652 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHROEDER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5055 SWAMP RD # 553 | ||||||||
| Address2: | |||||||||
| City: | FOUNTAINVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189239643 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 55 N GILBERT ST | ||||||||
| Address2: | TINTON FALLS VA - CBOC, BLDG 4, STE 4101 | ||||||||
| City: | TINTON FALLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077014955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7328424751 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 08/03/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD038967L | PA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | MD038967-L | 01 | PA | MEDICAL EXAMINERS LICENSE | OTHER |