Provider Demographics
NPI: | 1376514687 |
---|---|
Name: | SCHWARTZ, ELIZABETH CLARICE (CNM, NP) |
Entity Type: | Individual |
Prefix: | |
First Name: | ELIZABETH |
Middle Name: | CLARICE |
Last Name: | SCHWARTZ |
Suffix: | |
Gender: | F |
Credentials: | CNM, NP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2570 ROUTE 9W STE 10 |
Mailing Address - Street 2: | |
Mailing Address - City: | CORNWALL |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 12518-1370 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 845-220-3100 |
Mailing Address - Fax: | 845-534-2940 |
Practice Address - Street 1: | 147 LAKE ST |
Practice Address - Street 2: | |
Practice Address - City: | NEWBURGH |
Practice Address - State: | NY |
Practice Address - Zip Code: | 12550-5263 |
Practice Address - Country: | US |
Practice Address - Phone: | 845-563-8000 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-01-27 |
Last Update Date: | 2018-12-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | F360156 | 363LX0001X |
NY | F000791 | 176B00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 176B00000X | Other Service Providers | Midwife | |
No | 363LX0001X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | 01924767 | Medicaid | |
NY | 01924767 | Medicaid | |
Q14764 | Medicare UPIN |