Provider Demographics
NPI:1164414330
Name:SCHWARZWALD, EVAN HOWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:HOWARD
Last Name:SCHWARZWALD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:488 GREAT NECK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4308
Mailing Address - Country:US
Mailing Address - Phone:516-482-6747
Mailing Address - Fax:516-482-4851
Practice Address - Street 1:488 GREAT NECK RD
Practice Address - Street 2:SUITE 300
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4308
Practice Address - Country:US
Practice Address - Phone:516-482-6747
Practice Address - Fax:516-482-4851
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY174913207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
F40873Medicare UPIN
NY03L801Medicare PIN