Basic Information
Provider Information | |||||||||
NPI: | 1699799312 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SCHWARTZ | ||||||||
FirstName: | CHARLES | ||||||||
MiddleName: | I | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 319 S MANNING BLVD STE 106 | ||||||||
Address2: |   | ||||||||
City: | ALBANY | ||||||||
State: | NY | ||||||||
PostalCode: | 122081743 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5184380507 | ||||||||
FaxNumber: | 5184380981 | ||||||||
Practice Location | |||||||||
Address1: | 19 WEST AVE STE 103 | ||||||||
Address2: |   | ||||||||
City: | SARATOGA SPRINGS | ||||||||
State: | NY | ||||||||
PostalCode: | 128666052 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5185830111 | ||||||||
FaxNumber: | 5185832426 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/26/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 160913 | NY | Y |   | Allopathic & Osteopathic Physicians | Urology |   |
ID Information
ID | Type | State | Issuer | Description | 1099051 | 01 | NY | GHI PPO | OTHER | 10001837 | 01 | NY | CDP | OTHER | 000434036009 | 01 | NY | BLUE SHIELD OF NORTHEASTE | OTHER | 92953 | 01 | NY | GHI HMO | OTHER | 4S2492 | 01 | NY | EMPIRE BLUE CROSS BLUE SH | OTHER | 7410002 | 01 | NY | AETNA | OTHER |