Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 308768 | NY |
NPI | 1063822112 |
---|---|
Provider Name | Justin Schwarz |
First Address | Newburgh, NY 12550-2303 |
Second Address | New York, NY 10065-4870 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2014 |
Last Update Date | 17/08/2021 |