Individual provider Active NPI

Jan Schreuder, M.D.

  • Anesthesiology Physician
  • New York, NY
National Provider Identifier
1003964446
Registry record updated Oct 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
162460 Issued in NY
Practice address
60 E End Ave
New York, NY 10028-7907
Phone
(212) 734-8874
NPI assigned
Jan 8, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 162460 NY Primary

Addresses

Primary practice location

60 E End Ave
New York, NY 10028-7907

Mailing address

PO Box 270
Massapequa Park, NY 11762-0270
Phone (631) 264-2035

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041014001193 NY Practitioner - Anesthesiology 4688634504 Reassigns benefits to 2 organizations
Practice locations: Brooklyn, NY

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
162460NYMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kips Bay Endoscopy Center, LLC CurrentSince Aug 1, 2014 Accepting new patients
Advantage Anesthesiology Anesthesiology Past Accepting new patients

Locations

535 2nd Ave
New York, NY 10016
Phone (212) 447-1609

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287014400000",
    "number": "1003964446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 270",
            "city": "MASSAPEQUA PARK",
            "state": "NY",
            "postal_code": "117620270",
            "telephone_number": "631-264-2035",
            "fax_number": "631-264-1418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 E END AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100287907",
            "telephone_number": "212-734-8874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHREUDER",
        "first_name": "JAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-08",
        "last_updated": "2010-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "162460",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.