Provider Demographics
NPI:1447210125
Name:SCHWARTZ, MICHELE (PA)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 FOX CROFT VLG
Mailing Address - Street 2:
Mailing Address - City:LOCH SHELDRAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12759-5407
Mailing Address - Country:US
Mailing Address - Phone:845-434-4763
Mailing Address - Fax:718-567-4077
Practice Address - Street 1:800 POLY PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7104
Practice Address - Country:US
Practice Address - Phone:718-630-3625
Practice Address - Fax:718-567-4077
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001408363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical