Healthcare Provider Details

I. General information

NPI: 1235164120
Provider Name (Legal Business Name): BENJAMIN MICHAEL SCHWARTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 POTTER BLVD
BRIGHTWATERS NY
11718-1830
US

IV. Provider business mailing address

404 POTTER BLVD
BRIGHTWATERS NY
11718-1830
US

V. Phone/Fax

Practice location:
  • Phone: 631-376-0055
  • Fax: 631-376-0099
Mailing address:
  • Phone: 631-376-0055
  • Fax: 631-376-0099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number205481
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number205481
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: