Healthcare Provider Details

I. General information

NPI: 1609828672
Provider Name (Legal Business Name): SCHWARTZ GYNECOLOGIC ONCOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 POTTER BOULEVARD
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 TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BENJAMIN M. SCHWARTZ
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 631-376-0055