Healthcare Provider Details

I. General information

NPI: 1316070881
Provider Name (Legal Business Name): JAMES GLENN SCHWEER BRAMLETTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAMES GLENN SCHWEER MD

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE
HACKENSACK NJ
07601-1915
US

IV. Provider business mailing address

2825 OAK LAWN AVE UNIT 192749
DALLAS TX
75219-4688
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-2200
  • Fax: 201-489-2812
Mailing address:
  • Phone: 510-683-9500
  • Fax: 877-880-2039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number66866
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number55163
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC53193
License Number StateCA

VII. Legacy identifiers

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

# 1
Identifier0499722
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: