Provider Demographics
NPI:1811907017
Name:SCHWARTZ, EVAN (MD)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:
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 1:3016 30TH DR STE 1B
Mailing Address - Street 2:PARK LENOX ORTHOPAEDICS, PC
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1890
Mailing Address - Country:US
Mailing Address - Phone:718-558-1975
Mailing Address - Fax:718-558-1617
Practice Address - Street 1:3016 30TH DR STE 1B
Practice Address - Street 2:PARK LENOX ORTHOPAEDICS, PC
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1890
Practice Address - Country:US
Practice Address - Phone:718-558-1975
Practice Address - Fax:718-558-1617
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150904-1207X00000X, 207XS0114X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY068371OtherBLUE CROSS
NY01055398Medicaid
37909OtherAETNA
NY0006240OtherGHI
DS462OtherOXFORD
06240BMedicare ID - Type Unspecified
DS462OtherOXFORD
NY068371OtherBLUE CROSS
NY01055398Medicaid
NYA100017326Medicare PIN
NY0006240OtherGHI