Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 045860 | NY |
NPI | 1083614804 |
---|---|
Provider Name | Dr. Steven Schwartz |
First Address | Port Jefferson Station, NY 11776-1372 |
Second Address | Port Jefferson Station, NY 11776-1372 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2005 |
Last Update Date | 06/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H59671 | (02) | NY |