Healthcare Provider Details

I. General information

NPI: 1366443780
Provider Name (Legal Business Name): GARY D SCHWARTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE SUITE 516
HACKENSACK NJ
07601-1997
US

IV. Provider business mailing address

20 PROSPECT AVE STE 516
HACKENSACK NJ
07601-1989
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-8989
  • Fax: 201-996-5765
Mailing address:
  • Phone: 973-223-0418
  • Fax: 973-547-9177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA05961700
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: