1891823704 NPI number — DR. JENNIFER N FUNG-SCHWARTZ D.P.M.

Table of content: DR. JENNIFER N FUNG-SCHWARTZ D.P.M. (NPI 1891823704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891823704 NPI number — DR. JENNIFER N FUNG-SCHWARTZ D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FUNG-SCHWARTZ
Provider First Name:
JENNIFER
Provider Middle Name:
N
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
F

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:
1891823704
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:
50 W 97TH ST
Provider Second Line Business Mailing Address:
SUITE 1A
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10025-6053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-678-2333
Provider Business Mailing Address Fax Number:
212-678-9366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 W 97TH ST
Provider Second Line Business Practice Location Address:
SUITE 1A
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10025-6053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-678-2333
Provider Business Practice Location Address Fax Number:
212-678-9366
Provider Enumeration Date:
03/01/2007

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: 213E00000X , with the licence number:  N004889 , 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: NS4207 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P62991 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6200711 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: CIGNA . This is a "3281902" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01475007 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18776838252 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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