Provider Demographics
NPI:1518922012
Name:SCHWARTZ, MICHAEL HOWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HOWARD
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 MARCUS AVE
Mailing Address - Street 2:STE. N-10
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1011
Mailing Address - Country:US
Mailing Address - Phone:516-775-1818
Mailing Address - Fax:516-775-0892
Practice Address - Street 1:2001 MARCUS AVE
Practice Address - Street 2:STE. N-10
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042-1011
Practice Address - Country:US
Practice Address - Phone:516-775-1818
Practice Address - Fax:516-775-0892
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0408511223P0106X, 1223X0008X, 204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
No1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01145546Medicaid
NYT93347Medicare UPIN