Provider Demographics
NPI:1225564701
Name:SCHWALB, LEAH DANIELLE
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:DANIELLE
Last Name:SCHWALB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 FISKE ST
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2404
Mailing Address - Country:US
Mailing Address - Phone:845-323-0172
Mailing Address - Fax:
Practice Address - Street 1:820 FISKE ST
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2404
Practice Address - Country:US
Practice Address - Phone:845-323-0172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0601781223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry