Provider Demographics
NPI:1962419440
Name:SCHWARTZ, NICHOLAS A (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:A
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 1:156 5TH AVE
Mailing Address - Street 2:SUITE 414
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-7002
Mailing Address - Country:US
Mailing Address - Phone:212-465-2562
Mailing Address - Fax:212-675-2975
Practice Address - Street 1:156 5TH AVE
Practice Address - Street 2:SUITE 414
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7002
Practice Address - Country:US
Practice Address - Phone:212-465-2562
Practice Address - Fax:212-675-2975
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY214514207P00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02040155Medicaid
NY02040155Medicaid
NY0025UNMedicare PIN