Healthcare Provider Details

I. General information

NPI: 1831159904
Provider Name (Legal Business Name): JEFFREY M SCHWARZ PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 6 STREET
BROOKLYN NY
11215
US

IV. Provider business mailing address

PO BOX 5450
NEW YORK NY
10087-5450
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-3139
  • Fax: 718-780-3774
Mailing address:
  • Phone: 718-780-3139
  • Fax: 718-780-3774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number005935
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: