Provider Demographics
NPI:1639234107
Name:SCHWARTZ, ALAN (OD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 CAFFREY AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5249
Mailing Address - Country:US
Mailing Address - Phone:908-838-4056
Mailing Address - Fax:718-327-6481
Practice Address - Street 1:4601 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2631
Practice Address - Country:US
Practice Address - Phone:845-436-5577
Practice Address - Fax:845-436-5577
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005141152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01208180Medicaid
NYC1T901Medicare ID - Type Unspecified
NY01208180Medicaid