Provider Demographics
NPI:1144321837
Name:SCHWARTZ, FREDRIC JOEL (PT)
Entity type:Individual
Prefix:MR
First Name:FREDRIC
Middle Name:JOEL
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 HEMLOCK LN
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-1432
Mailing Address - Country:US
Mailing Address - Phone:516-554-7165
Mailing Address - Fax:516-625-7701
Practice Address - Street 1:55 BRYANT AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1139
Practice Address - Country:US
Practice Address - Phone:516-554-7165
Practice Address - Fax:516-625-7701
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3509225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ 53451Medicare ID - Type Unspecified