1407829039 NPI number — MICHAEL S SCHWARTZMAN MD

Table of content: MICHAEL S SCHWARTZMAN MD (NPI 1407829039)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407829039 NPI number — MICHAEL S SCHWARTZMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHWARTZMAN
Provider First Name:
MICHAEL
Provider Middle Name:
S
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:
1407829039
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
99 E STATE ST
Provider Second Line Business Mailing Address:
PO BOX 1250
Provider Business Mailing Address City Name:
GLOVERSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12078-1203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-775-4205
Provider Business Mailing Address Fax Number:
518-773-5456

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99 EAST STATE ST
Provider Second Line Business Practice Location Address:
MAB SUITE 106
Provider Business Practice Location Address City Name:
GLOVERSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-775-4300
Provider Business Practice Location Address Fax Number:
518-773-4309
Provider Enumeration Date:
02/13/2006

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: 207RN0300X , with the licence number:  143087 , 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: 6021187 . This is a "MVP HEALTHPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01163120 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000418601001 . This is a "BSH NE NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10031871 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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