Provider Demographics
NPI:1811916455
Name:SCHWARTZ, THEODORE (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
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 1:525 EAST 68TH STREET BOX 99
Mailing Address - Street 2:NEW YORK PRESBYTERIAN / WEILL CORNELL MEDICAL CENTER
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065
Mailing Address - Country:US
Mailing Address - Phone:212-746-5620
Mailing Address - Fax:646-962-0118
Practice Address - Street 1:525 EAST 68TH STREET BOX 99
Practice Address - Street 2:NEW YORK PRESBYTERIAN / WEILL CORNELL MEDICAL CENTER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065
Practice Address - Country:US
Practice Address - Phone:212-746-5620
Practice Address - Fax:646-962-0118
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218102207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02161017Medicaid
NY02161017Medicaid