MEDICARE: DIANE C SCHWARTZ MD

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	207R00000X	Internal Medicine Physician	MA072367	NJ

General Provider Information

NPI Number	:	1861400764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE C SCHWARTZ MD

Provider Business Mailing Address
First Line	:	66 EDWARD STREET
Second Line	:
City	:	DEMAREST
State	:	NJ
Zip	:	07627
Country	:	US
Telephone Number	:	201-784-0696
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 OLD TAPPAN ROAD
Second Line	:
City	:	OLD TAPPAN
State	:	NJ
Zip	:	07675
Country	:	US
Telephone Number	:	201-666-1000
Fax Number	:

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	07/08/2007

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