Provider Demographics
NPI:1356492367
Name:ERIC J. HARTMAN M.D. LLC
Entity Type:Organization
Organization Name:ERIC J. HARTMAN M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JESSE
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-265-9363
Mailing Address - Street 1:200 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-2902
Mailing Address - Country:US
Mailing Address - Phone:609-265-9363
Mailing Address - Fax:609-265-9424
Practice Address - Street 1:200 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-2902
Practice Address - Country:US
Practice Address - Phone:609-265-9363
Practice Address - Fax:609-265-9424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06415800207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ874611Medicare PIN
NJG28991Medicare UPIN
NJ4644190001Medicare NSC