=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275634651
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK HAROLD SWARTZ M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 E 124TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10035-1815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-410-8457
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 555 THE PKWY
-----------------------------------------------------
City | MAMARONECK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10543-4016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-698-7874
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 120783
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------