Healthcare Provider Details

I. General information

NPI: 1598967028
Provider Name (Legal Business Name): GARY D. SCHWARTZ, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 08/31/2016
Certification Date:
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: 201-845-9300
  • Fax: 201-845-9301

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: DR. GARY D SCHWARTZ
Title or Position: OWNER
Credential: MD
Phone: 201-488-8989