Healthcare Provider Details

I. General information

NPI: 1700686383
Provider Name (Legal Business Name): MICHAEL LAWRENCE SCHWARTZ NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 SOUTHERN BLVD
NESCONSET NY
11767-1090
US

IV. Provider business mailing address

59 SOUTHERN BLVD
NESCONSET NY
11767-1090
US

V. Phone/Fax

Practice location:
  • Phone: 631-418-8069
  • Fax:
Mailing address:
  • Phone: 631-418-8069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number312306
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number312306
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number312458
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number695264
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: