Healthcare Provider Details

I. General information

NPI: 1811629298
Provider Name (Legal Business Name): JENNIFER SCHWARTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2022
Last Update Date: 06/25/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 ARGYLE RD
ORANGE CT
06477-2914
US

IV. Provider business mailing address

236 ARGYLE RD
ORANGE CT
06477-2914
US

V. Phone/Fax

Practice location:
  • Phone: 203-799-7644
  • Fax:
Mailing address:
  • Phone: 203-799-7644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number173404
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: