Provider Demographics
NPI:1083601033
Name:SCHWARTZ, MALCOLM (MD)
Entity Type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-3133
Mailing Address - Country:US
Mailing Address - Phone:908-654-5100
Mailing Address - Fax:908-789-8755
Practice Address - Street 1:275 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-3133
Practice Address - Country:US
Practice Address - Phone:908-654-5100
Practice Address - Fax:908-789-8755
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02784700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1280104Medicaid
NJD99056Medicare UPIN
NJ1280104Medicaid