Provider Demographics
NPI:1730484189
Name:HARTWIG, JEFFREY CHARLES
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CHARLES
Last Name:HARTWIG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 114
Mailing Address - Street 2:
Mailing Address - City:LEE CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:13363-0114
Mailing Address - Country:US
Mailing Address - Phone:607-341-8433
Mailing Address - Fax:
Practice Address - Street 1:5396 STATE HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-3716
Practice Address - Country:US
Practice Address - Phone:607-334-6029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-17
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055393-01183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist