Provider Demographics
NPI:1619983640
Name:SCHWARTZ, SUSAN JEAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JEAN
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:45 CONDIT CT
Mailing Address - Street 2:
Mailing Address - City:ROSELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07068-1346
Mailing Address - Country:US
Mailing Address - Phone:973-226-7904
Mailing Address - Fax:
Practice Address - Street 1:66 WEST GILBERT STREET
Practice Address - Street 2:LIVINGSTON HOSPITAL PHYSICIANS
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-4918
Practice Address - Country:US
Practice Address - Phone:732-212-0060
Practice Address - Fax:732-212-0061
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00000600363AM0700X
NY001624-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ180468TS6Medicare PIN