Provider Demographics
NPI:1053313940
Name:HARTMAN, BARRY JAY (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:JAY
Last Name:HARTMAN
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 1:407 E 70TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5327
Mailing Address - Country:US
Mailing Address - Phone:212-744-4882
Mailing Address - Fax:212-737-5783
Practice Address - Street 1:407 E 70TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5327
Practice Address - Country:US
Practice Address - Phone:212-744-4882
Practice Address - Fax:212-737-5783
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123618207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY007699754Medicaid
NY007699754Medicaid
C09622Medicare UPIN