Basic Information
| Provider Information | |||||||||
| NPI: | 1164414330 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHWARZWALD | ||||||||
| FirstName: | EVAN | ||||||||
| MiddleName: | HOWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 488 GREAT NECK RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110214308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164826747 | ||||||||
| FaxNumber: | 5164824851 | ||||||||
| Practice Location | |||||||||
| Address1: | 488 GREAT NECK RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110214308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164826747 | ||||||||
| FaxNumber: | 5164824851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2005 | ||||||||
| LastUpdateDate: | 07/28/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 174913 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.