Provider Demographics
NPI:1376043976
Name:SCHWARTZ, MELISSA A (DO)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:A
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HSC LEVEL 4 ROOM 176
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8430
Mailing Address - Country:US
Mailing Address - Phone:631-638-8517
Mailing Address - Fax:
Practice Address - Street 1:HSC LEVEL 4, ROOM 176
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-5152
Practice Address - Country:US
Practice Address - Phone:631-638-8517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
CO390200000X
NY313569208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program