Basic Information
| Provider Information | |||||||||
| NPI: | 1073620118 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHWAITZBERG | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 77 GOODELL STREET | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142031243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166459694 | ||||||||
| FaxNumber: | 7168456699 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 HIGH STREET | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142031126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168592268 | ||||||||
| FaxNumber: | 7168594580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 03/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 55759 | MA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 278662 | NY | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 04145117 | 05 | NY | MEDICAID | BLUE CROSS | 01 | MA | 1073620118 | OTHER |