Provider Demographics
NPI:1003144411
Name:HARTER, GEORGIA N (MA)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:N
Last Name:HARTER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 CHURCH STREET
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086
Mailing Address - Country:US
Mailing Address - Phone:716-681-6722
Mailing Address - Fax:
Practice Address - Street 1:56 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14086
Practice Address - Country:US
Practice Address - Phone:716-681-6722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001289-1231H00000X
NY14000003279332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01384849Medicaid
NY286551Medicare PIN