Provider Demographics
NPI:1699471086
Name:SCHWARTZ, MARK JESSE (NP)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JESSE
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30114
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-0114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:750 VETERANS MEMORIAL HIGHWAY
Practice Address - Street 2:SUITE 205
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2943
Practice Address - Country:US
Practice Address - Phone:718-801-6318
Practice Address - Fax:718-798-0988
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY751097163W00000X
NY351348363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse