Provider Demographics
NPI:1497754972
Name:HARDIES, MICHAEL J (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:HARDIES
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 1:427 GUY PARK AVE - PRIMARY CARE & SPECIALTY CARE DEPT.
Mailing Address - Street 2:ST. MARY'S HOSPITAL AT AMSTERDAM
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010
Mailing Address - Country:US
Mailing Address - Phone:518-841-7430
Mailing Address - Fax:518-841-7121
Practice Address - Street 1:380 GUY PARK AVE
Practice Address - Street 2:ST. MARY'S HOSPITAL, FAM HLTH CNTR AT CARONDELET PAVILI
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010
Practice Address - Country:US
Practice Address - Phone:518-841-7415
Practice Address - Fax:518-841-7422
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1240881207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10000847OtherC.D.P.H.P
NY714319OtherM.V.P
NY00350096Medicaid
NYRA1455Medicare ID - Type Unspecified
NY00350096Medicaid