1558446054 NPI number — DR. LAWRENCE SEAN SCHWARTZ PH.D.

Table of content: DR. LAWRENCE SEAN SCHWARTZ PH.D. (NPI 1558446054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558446054 NPI number — DR. LAWRENCE SEAN SCHWARTZ PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHWARTZ
Provider First Name:
LAWRENCE
Provider Middle Name:
SEAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
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:
1558446054
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
77 VIRGINIA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOBBS FERRY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10522-1915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-693-3693
Provider Business Mailing Address Fax Number:
914-693-3693

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
240 CENTRAL PARK S
Provider Second Line Business Practice Location Address:
SUITE 2P
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10019-1457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-946-1051
Provider Business Practice Location Address Fax Number:
914-693-3693
Provider Enumeration Date:
10/25/2006

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: 103TC0700X , with the licence number:  012758 , 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: 7552193 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02396454 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P1292190 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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