Provider Demographics
NPI:1316021090
Name:DOUGLAS A SCHWARTZ, D.O., P.C. EASTSIDE MEDICAL GROUP
Entity Type:Organization
Organization Name:DOUGLAS A SCHWARTZ, D.O., P.C. EASTSIDE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:212-644-6900
Mailing Address - Street 1:211 E 43RD ST RM 2300
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-4707
Mailing Address - Country:US
Mailing Address - Phone:212-644-6900
Mailing Address - Fax:212-644-9600
Practice Address - Street 1:211 E 43RD ST RM 2300
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4707
Practice Address - Country:US
Practice Address - Phone:212-644-6900
Practice Address - Fax:212-644-9600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184275208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01591226Medicaid
NY97K261Medicare ID - Type Unspecified
NY01591226Medicaid
NYF40004Medicare UPIN