Provider Demographics
NPI:1316918386
Name:SCHWARTZ, IRWIN L (MD)
Entity type:Individual
Prefix:DR
First Name:IRWIN
Middle Name:L
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MAIN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2918
Mailing Address - Country:US
Mailing Address - Phone:631-751-7676
Mailing Address - Fax:
Practice Address - Street 1:200 MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2918
Practice Address - Country:US
Practice Address - Phone:631-751-7676
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115742080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC08166Medicare UPIN