Provider Demographics
NPI:1811932247
Name:POTTICK-SCHWARTZ, ELIANE (MD)
Entity type:Individual
Prefix:DR
First Name:ELIANE
Middle Name:
Last Name:POTTICK-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 1:780 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-1706
Mailing Address - Country:US
Mailing Address - Phone:201-836-7664
Mailing Address - Fax:201-836-5710
Practice Address - Street 1:780 CEDAR LN
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-1706
Practice Address - Country:US
Practice Address - Phone:201-836-7664
Practice Address - Fax:201-836-5710
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07195300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ046952Medicare ID - Type Unspecified
NJH34436Medicare UPIN