1356378442 NPI number — JEREMY J SCHWARTZ MD

Table of content: JEREMY J SCHWARTZ MD (NPI 1356378442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356378442 NPI number — JEREMY J SCHWARTZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHWARTZ
Provider First Name:
JEREMY
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356378442
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
575 LEXINGTON AVE
Provider Second Line Business Mailing Address:
9TH FLOOR
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10022-6102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-962-5110
Provider Business Mailing Address Fax Number:
646-962-0156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
260 W. SUNRISE HWY, STE. 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALLEY STREAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11581-1015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-825-3600
Provider Business Practice Location Address Fax Number:
516-872-5137
Provider Enumeration Date:
06/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  MD22281 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: C131578 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: 224102 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02632988 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".