Healthcare Provider Details

I. General information

NPI: 1619322955
Provider Name (Legal Business Name): NICHOLAS SZWABA D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2016
Last Update Date: 09/08/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 NJ-23
WAYNE NJ
07470-1901
US

IV. Provider business mailing address

4243 RICHMOND AVE
STATEN ISLAND NY
10312-6221
US

V. Phone/Fax

Practice location:
  • Phone: 917-903-1532
  • Fax:
Mailing address:
  • Phone: 718-554-4098
  • Fax: 718-554-5494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number006885
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00352300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License Number25MD00352300
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License Number006885
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number006885
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number25MD00352300
License Number StateNJ
# 7
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number006885
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number25MD00352300
License Number StateNJ
# 9
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number006885
License Number StateNY
# 10
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00352300
License Number StateNJ
# 11
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number006885
License Number StateNY
# 12
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number25MD00352300
License Number StateNJ
# 13
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number006885
License Number StateNY
# 14
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 15
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number25MD00352300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: