Healthcare Provider Details

I. General information

NPI: 1407242571
Provider Name (Legal Business Name): RICHARD L SWERDLIK MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 BRIGHTON BEACH AVE STE 3
BROOKLYN NY
11235-8067
US

IV. Provider business mailing address

302 MANOR RD
STATEN ISLAND NY
10314-2408
US

V. Phone/Fax

Practice location:
  • Phone: 718-946-7557
  • Fax: 718-815-8122
Mailing address:
  • Phone: 718-815-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number16677
License Number StateNY

VIII. Authorized Official

Name: RICHARD L SWERDLIK
Title or Position: CEO
Credential: M.D
Phone: 718-815-1000