Healthcare Provider Details

I. General information

NPI: 1801851076
Provider Name (Legal Business Name): MALCOLM S SCHWARTZ D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 PAVILION AVE
LONG BRANCH NJ
07740-6415
US

IV. Provider business mailing address

384 OCEAN AVE N SUITE 4D
LONG BRANCH NJ
07740-7763
US

V. Phone/Fax

Practice location:
  • Phone: 732-923-1170
  • Fax: 732-923-1176
Mailing address:
  • Phone: 732-923-1170
  • Fax: 732-923-1176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number25MB02390300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: