Provider Demographics
NPI:1851958227
Name:SCHWARTZ, BENJAMIN HARRISON (LAC)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:HARRISON
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 W 54TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5978
Mailing Address - Country:US
Mailing Address - Phone:475-290-0722
Mailing Address - Fax:
Practice Address - Street 1:550 W 54TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5978
Practice Address - Country:US
Practice Address - Phone:475-290-0722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006532171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006532OtherOUT OF NETWORK