Provider Demographics
NPI:1265468136
Name:HANTMAN, MORTON M (MD)
Entity Type:Individual
Prefix:DR
First Name:MORTON
Middle Name:M
Last Name:HANTMAN
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 1:175 MEMORIAL HWY
Mailing Address - Street 2:SUITE 1-7
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5635
Mailing Address - Country:US
Mailing Address - Phone:914-632-3814
Mailing Address - Fax:914-632-7212
Practice Address - Street 1:175 MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5635
Practice Address - Country:US
Practice Address - Phone:914-632-3814
Practice Address - Fax:914-632-7212
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136178174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00600380Medicaid
NY50A261Medicare ID - Type Unspecified
NY00600380Medicaid