Provider Demographics
NPI:1154480192
Name:HARTSTEIN, JONATHAN ERIC (PT)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:ERIC
Last Name:HARTSTEIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2736 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEXLEY
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2534
Mailing Address - Country:US
Mailing Address - Phone:614-586-1305
Mailing Address - Fax:614-586-1307
Practice Address - Street 1:2736 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BEXLEY
Practice Address - State:OH
Practice Address - Zip Code:43209-2534
Practice Address - Country:US
Practice Address - Phone:614-586-1305
Practice Address - Fax:614-586-1307
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 08734174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2449587Medicaid
OH2449587Medicaid