Basic Information
| Provider Information | |||||||||
| NPI: | 1356378442 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHWARTZ | ||||||||
| FirstName: | JEREMY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 575 LEXINGTON AVE | ||||||||
| Address2: | 9TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100226102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6469625110 | ||||||||
| FaxNumber: | 6469620156 | ||||||||
| Practice Location | |||||||||
| Address1: | 260 W. SUNRISE HWY, STE. 200 | ||||||||
| Address2: | |||||||||
| City: | VALLEY STREAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115811015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5168253600 | ||||||||
| FaxNumber: | 5168725137 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 04/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | MD22281 | ME | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | C131578 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | 224102 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 02632988 | 05 | NY | MEDICAID |