MEDICARE: DR. ISA SCHWARZBERG DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	25MD00281000	NJ
2	213ES0131X	Foot Surgery Podiatrist	5901002194	MI
3	213ES0131X	Foot Surgery Podiatrist	N005990	NY

General Provider Information

NPI Number	:	1063417491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ISA SCHWARZBERG DPM

Provider Business Mailing Address
First Line	:	240 W PASSAIC ST
Second Line	:	SUITE 4
City	:	MAYWOOD
State	:	NJ
Zip	:	07607-1264
Country	:	US
Telephone Number	:	201-880-6000
Fax Number	:	201-880-5999

Provider Business Practice Location Address
First Line	:	240 W PASSAIC ST
Second Line	:	SUITE 4
City	:	MAYWOOD
State	:	NJ
Zip	:	07607-1264
Country	:	US
Telephone Number	:	201-880-6000
Fax Number	:	201-880-5999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	08/25/2010

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