Provider Demographics
NPI:1811175102
Name:SCHWARTZ, MARK L (DPM)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 BAY 22 ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-6105
Mailing Address - Country:US
Mailing Address - Phone:718-372-2282
Mailing Address - Fax:718-449-5639
Practice Address - Street 1:247 BAY 22 STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-6105
Practice Address - Country:US
Practice Address - Phone:718-372-2282
Practice Address - Fax:718-449-5639
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003034213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P32871OtherEMPIRE BLUE CROSS
0002764OtherGROUP HEALTH INCORPORATED
NY00479754Medicaid
P32871OtherEMPIRE BLUE CROSS
P32871Medicare PIN