Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | 165144 | NY |
Y | 207RG0300X | Geriatric Medicine | 165144 | NY |
NPI | 1831185222 |
---|---|
Provider Name | Jerrold P Schwartz |
First Address | Johnson City, NY 13790-2558 |
Second Address | Johnson City, NY 13790-1810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2005 |
Last Update Date | 06/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02313495 | (05) | NY |
D06533 | (02) |