Provider Demographics
NPI:1265415962
Name:SCHWARTZ, CAROLYN L (MD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:L
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 DUTCH HILL RD STE 18
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-1722
Mailing Address - Country:US
Mailing Address - Phone:845-359-4770
Mailing Address - Fax:845-359-0017
Practice Address - Street 1:60 DUTCH HILL RD STE 18
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962-1722
Practice Address - Country:US
Practice Address - Phone:845-359-4770
Practice Address - Fax:458-359-0017
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06728100207N00000X
NY310846207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0440329OtherMEDICAID NON PAR NUMBER
NJ010309DF5Medicare PIN
NJ0440329OtherMEDICAID NON PAR NUMBER
G71219Medicare UPIN
NJ010309YAENMedicare PIN