Healthcare Provider Details

I. General information

NPI: 1568868560
Provider Name (Legal Business Name): ELIZABETH SCHWENNKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2014
Last Update Date: 06/28/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 DRIVING PARK AVE
NEWARK NY
14513-1090
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 315-359-2847
  • Fax:
Mailing address:
  • Phone: 585-922-1469
  • Fax: 585-922-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number018176
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number18176
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: