Provider Demographics
NPI:1972603769
Name:SCHWARTZ, DEENA J (NP)
Entity type:Individual
Prefix:MS
First Name:DEENA
Middle Name:J
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 EAST STATE ST #257
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-3209
Mailing Address - Country:US
Mailing Address - Phone:607-227-2246
Mailing Address - Fax:607-687-6396
Practice Address - Street 1:1062 STATE ROUTE 38
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827
Practice Address - Country:US
Practice Address - Phone:607-687-4000
Practice Address - Fax:607-687-6396
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401101363LP0808X
NYF300121363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF401101OtherPNP LICENSE NUMBER
NYF300121OtherNP LICENSE NUMBER
39062AOtherGROUP MEDICARE NUMBER
39062AOtherGROUP MEDICARE NUMBER
39062AOtherGROUP MEDICARE NUMBER