Provider Demographics
NPI:1417956822
Name:HART, PATRICIA M (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:M
Last Name:HART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 EASTERN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-4570
Mailing Address - Country:US
Mailing Address - Phone:718-282-7300
Mailing Address - Fax:718-282-4643
Practice Address - Street 1:391 EASTERN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-4570
Practice Address - Country:US
Practice Address - Phone:718-282-7300
Practice Address - Fax:718-282-4643
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2019-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128845207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00672353Medicaid
NY00672353Medicaid