Healthcare Provider Details

I. General information

NPI: 1215182324
Provider Name (Legal Business Name): SHIMON SCHWARTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 E MAIN ST
MIDDLETOWN NY
10940-2650
US

IV. Provider business mailing address

26528 74TH AVE
GLEN OAKS NY
11004-1163
US

V. Phone/Fax

Practice location:
  • Phone: 845-333-1114
  • Fax: 845-333-1102
Mailing address:
  • Phone: 347-409-1871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number275539
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: