Provider Demographics
NPI:1265494249
Name:SCHWEITZER, AUDRA
Entity Type:Individual
Prefix:DR
First Name:AUDRA
Middle Name:
Last Name:SCHWEITZER
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 1:3030 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-2574
Mailing Address - Country:US
Mailing Address - Phone:914-607-6260
Mailing Address - Fax:914-607-6261
Practice Address - Street 1:3030 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577-2574
Practice Address - Country:US
Practice Address - Phone:914-607-6260
Practice Address - Fax:914-607-6261
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230258208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02551531Medicaid
NYI37711Medicare UPIN
NYI37711Medicare UPIN
NY657Y71Medicare ID - Type Unspecified
NY21316OtherHEALTHSOURCE
NY3C7997OtherHEALTHNET
NYP3400266OtherOXFORD
NY3487558OtherAETNA HMO
NY7439567OtherAETNA PPO