Provider Demographics
NPI:1003817313
Name:HARTMANN, RUPERT CARL (DO)
Entity Type:Individual
Prefix:DR
First Name:RUPERT
Middle Name:CARL
Last Name:HARTMANN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 CINNAMINSON AVE
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:NJ
Mailing Address - Zip Code:08065-1802
Mailing Address - Country:US
Mailing Address - Phone:856-829-4007
Mailing Address - Fax:856-786-7729
Practice Address - Street 1:943 CINNAMINSON AVE
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:NJ
Practice Address - Zip Code:08065-1802
Practice Address - Country:US
Practice Address - Phone:856-829-4007
Practice Address - Fax:856-786-7729
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB28896207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1857606Medicaid
NJ149996Medicare ID - Type Unspecified
NJE06157Medicare UPIN