Provider Demographics
NPI:1528175544
Name:SCHWARTZ, LAUREN ALYSSA (DPM)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ALYSSA
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 PLANDOME RD
Mailing Address - Street 2:# 2
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1974
Mailing Address - Country:US
Mailing Address - Phone:516-504-7586
Mailing Address - Fax:516-487-4156
Practice Address - Street 1:290 COMMUNITY DRIVE
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:516-504-7586
Practice Address - Fax:516-487-4156
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005323213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01774249Medicaid
NY02478Medicare PIN
NYP00661Medicare PIN
U66168Medicare UPIN
NY01774249Medicaid