Healthcare Provider Details

I. General information

NPI: 1922055045
Provider Name (Legal Business Name): SPECIALIST PEDS AT LICH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 AMITY ST
BROOKLYN NY
11201-6004
US

IV. Provider business mailing address

160 WATER ST 20FL
NEW YORK NY
10038-4922
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-1025
  • Fax:
Mailing address:
  • Phone: 212-256-3682
  • Fax: 212-256-3538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN SCHWARZ
Title or Position: MANAGING EMPLOYEE
Credential: MD
Phone: 718-780-1025