Provider Demographics
NPI:1083965453
Name:HARTSTEIN, RAIZY (MASTERS)
Entity Type:Individual
Prefix:
First Name:RAIZY
Middle Name:
Last Name:HARTSTEIN
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1947 54TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-1746
Mailing Address - Country:US
Mailing Address - Phone:718-692-3349
Mailing Address - Fax:718-692-3349
Practice Address - Street 1:1947 54 ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204
Practice Address - Country:US
Practice Address - Phone:718-692-3349
Practice Address - Fax:718-692-3349
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103467012174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist