Provider Demographics
NPI:1871960484
Name:DR. MARK SCHWARTZ, P.A.
Entity type:Organization
Organization Name:DR. MARK SCHWARTZ, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-819-8049
Mailing Address - Street 1:308 CHELSEA MANOR
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656
Mailing Address - Country:US
Mailing Address - Phone:201-819-8049
Mailing Address - Fax:201-746-0950
Practice Address - Street 1:308 CHELSEA MANOR
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07656
Practice Address - Country:US
Practice Address - Phone:201-819-8049
Practice Address - Fax:201-746-0950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06381000261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center