Provider Demographics
NPI:1164436325
Name:SCHWARTZ, MARK L (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 PASSAIC ST
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-5803
Mailing Address - Country:US
Mailing Address - Phone:201-783-0780
Mailing Address - Fax:201-664-0853
Practice Address - Street 1:293 PASSAIC ST
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-5803
Practice Address - Country:US
Practice Address - Phone:201-783-0780
Practice Address - Fax:201-664-0853
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197645-1208100000X
NJ25MB06381000208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ874625Medicare ID - Type Unspecified
NJG28992Medicare UPIN
NYA400134439Medicare Oscar/Certification
NJ435224Medicare Oscar/Certification