Provider Demographics
NPI:1295756005
Name:SCHWARTZ, MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BROADHOLLOW RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4905
Mailing Address - Country:US
Mailing Address - Phone:631-385-3313
Mailing Address - Fax:631-385-3346
Practice Address - Street 1:150 BROADHOLLOW RD
Practice Address - Street 2:SUITE 204
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4905
Practice Address - Country:US
Practice Address - Phone:631-385-3313
Practice Address - Fax:631-385-3346
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1382852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00782081Medicaid
NY04D881Medicare ID - Type Unspecified
NY00782081Medicaid