Provider Demographics
NPI:1164504817
Name:HARDAMA MEDICAL SERVICES
Entity Type:Organization
Organization Name:HARDAMA MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-417-3639
Mailing Address - Street 1:PO BOX 4853
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11551-4853
Mailing Address - Country:US
Mailing Address - Phone:516-417-3639
Mailing Address - Fax:
Practice Address - Street 1:305 ELM ST
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-3224
Practice Address - Country:US
Practice Address - Phone:516-417-3639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1968121208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWFW761Medicare PIN