Healthcare Provider Details

I. General information

NPI: 1407958481
Provider Name (Legal Business Name): BRUCE DANIEL SCHWEIGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 NORTH AVE, EAST
CRANFORD NJ
07016-2158
US

IV. Provider business mailing address

9520 63RD RD STE J
REGO PARK NY
11374-1145
US

V. Phone/Fax

Practice location:
  • Phone: 908-272-7500
  • Fax: 908-272-7502
Mailing address:
  • Phone: 718-459-1225
  • Fax: 718-459-5805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMA69103
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8066001
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: