=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053626267
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADINA SCHWAB RPA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2010
-----------------------------------------------------
Last Update Date | 04/25/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26901 76TH AVE STE 255
-----------------------------------------------------
City | NEW HYDE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11040-1433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-558-2013
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1708 CENTRAL AVE
-----------------------------------------------------
City | HIGHLAND PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08904-3711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-558-2013
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------