Provider Demographics
NPI:1801851076
Name:SCHWARTZ, MALCOLM S (DO)
Entity Type:Individual
Prefix:
First Name:MALCOLM
Middle Name:S
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 OCEAN AVE N
Mailing Address - Street 2:SUITE 4D
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-7763
Mailing Address - Country:US
Mailing Address - Phone:732-923-1170
Mailing Address - Fax:732-923-1176
Practice Address - Street 1:133 PAVILION AVE
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6415
Practice Address - Country:US
Practice Address - Phone:732-923-1170
Practice Address - Fax:732-923-1176
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB023903002080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0808105Medicaid
NJ0808105Medicaid
NJG37936Medicare UPIN