Provider Demographics
NPI:1902860364
Name:SCHWARTZ, BENNETT K (MD)
Entity Type:Individual
Prefix:
First Name:BENNETT
Middle Name:K
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 E EVESHAM RD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4501
Mailing Address - Country:US
Mailing Address - Phone:856-772-2221
Mailing Address - Fax:856-772-0936
Practice Address - Street 1:2301 E EVESHAM RD
Practice Address - Street 2:SUITE 403
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4501
Practice Address - Country:US
Practice Address - Phone:856-772-2221
Practice Address - Fax:856-772-0936
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3318401Medicaid
SC514362Medicare PIN
C56609Medicare UPIN