Healthcare Provider Details

I. General information

NPI: 1467493528
Provider Name (Legal Business Name): PHILIP E SCHWEITZER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 02/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3184 GRAND CONCOURSE SUITE 2D
BRONX NY
10458-2611
US

IV. Provider business mailing address

4238 BRONX BLVD
BRONX NY
10466-2611
US

V. Phone/Fax

Practice location:
  • Phone: 718-584-0404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number105455
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: