Provider Demographics
NPI:1326198441
Name:SCHWING, WILLIAM MARK (CPO)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MARK
Last Name:SCHWING
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 E MAIN ST
Mailing Address - Street 2:BLDG. A SUITE 2
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2830
Mailing Address - Country:US
Mailing Address - Phone:631-360-6400
Mailing Address - Fax:631-360-6449
Practice Address - Street 1:329 E MAIN ST
Practice Address - Street 2:BLDG. A SUITE 2
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2830
Practice Address - Country:US
Practice Address - Phone:631-360-6400
Practice Address - Fax:631-360-6449
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02192501Medicaid
NYA2669088OtherOXFORD PROVIDER ID
NY165811OtherVYTRA PROVIDER ID.
NY3C7870OtherHEALTHNET PROVIDER ID
FL4146880002Medicare ID - Type UnspecifiedPROVIDER IDENTIFICATION
NYA2669088OtherOXFORD PROVIDER ID