Provider Demographics
NPI:1144207168
Name:SCHWARTZ, GLENN E (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:E
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:360 MERRICK RD FL 1
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2526
Mailing Address - Country:US
Mailing Address - Phone:165-887-3516
Mailing Address - Fax:516-887-0331
Practice Address - Street 1:777 SUNRISE HWY STE 200
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2950
Practice Address - Country:US
Practice Address - Phone:516-887-3516
Practice Address - Fax:516-887-0331
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1437252085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00881681Medicaid
NY0551AAMedicare PIN
NY07075KMedicare PIN
NY06544IMedicare PIN
NYC05410Medicare UPIN
NY00881681Medicaid
NY10D4313091Medicare PIN