Provider Demographics
NPI:1407016892
Name:SCHWAB, JENNIFER LANI (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LANI
Last Name:SCHWAB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 OLD BURRSTONE RD
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-4804
Mailing Address - Country:US
Mailing Address - Phone:315-797-2450
Mailing Address - Fax:
Practice Address - Street 1:1522 OLD BURRSTONE RD
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-4804
Practice Address - Country:US
Practice Address - Phone:315-797-2450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264778-1207V00000X
NJ25MA09149300207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology