Provider Demographics
NPI:1518943802
Name:HARTSDALE MEDICAL GROUP, P.C.
Entity Type:Organization
Organization Name:HARTSDALE MEDICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXWELL
Authorized Official - Middle Name:MANI
Authorized Official - Last Name:CHAIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-725-2010
Mailing Address - Street 1:180 E HARTSDALE AVE
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-3544
Mailing Address - Country:US
Mailing Address - Phone:914-725-2010
Mailing Address - Fax:914-725-6488
Practice Address - Street 1:180 E HARTSDALE AVE
Practice Address - Street 2:SUITE 1E
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-3544
Practice Address - Country:US
Practice Address - Phone:914-725-2010
Practice Address - Fax:914-725-6488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Not Answered207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00599748Medicaid
NY00599748Medicaid