Provider Demographics
NPI:1558326405
Name:SWEITZER, STEVEN G (PA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:G
Last Name:SWEITZER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 BEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-2700
Mailing Address - Country:US
Mailing Address - Phone:914-773-3005
Mailing Address - Fax:845-569-3352
Practice Address - Street 1:330 POWELL AVE
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3412
Practice Address - Country:US
Practice Address - Phone:845-569-3663
Practice Address - Fax:845-569-3352
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000143363A00000X
NY011395363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02324Medicare PIN
CT970000172Medicare ID - Type Unspecified