Provider Demographics
NPI:1356320188
Name:SCHWARTZ, GLENN F (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:F
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5416
Mailing Address - Country:US
Mailing Address - Phone:212-533-2760
Mailing Address - Fax:212-387-9143
Practice Address - Street 1:4 LEXINGTON AVE
Practice Address - Street 2:SUITE 1S
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5416
Practice Address - Country:US
Practice Address - Phone:212-533-2760
Practice Address - Fax:212-387-9143
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164604207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01102001Medicaid
NY01102001Medicaid
NYA64616Medicare UPIN