Provider Demographics
NPI:1477515344
Name:SCHWARTZ, KENNY ALAN A (MD)
Entity Type:Individual
Prefix:
First Name:KENNY ALAN
Middle Name:A
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 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-214-9907
Mailing Address - Fax:
Practice Address - Street 1:1000 EAST MOUNTAIN BLVD.
Practice Address - Street 2:
Practice Address - City:WILKES-BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-3731
Practice Address - Country:US
Practice Address - Phone:570-808-6026
Practice Address - Fax:570-808-3208
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148738-12084N0400X
PAMD4433172084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00838151Medicaid
NYC06811Medicare UPIN
NY00838151Medicaid
NY95507EL191Medicare PIN