Provider Demographics
NPI:1750507984
Name:HARTMAN, DAVID G (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 S KETCHAM AVE
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-3521
Mailing Address - Country:US
Mailing Address - Phone:631-691-8127
Mailing Address - Fax:
Practice Address - Street 1:181 S KETCHAM AVE
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-3521
Practice Address - Country:US
Practice Address - Phone:631-691-8127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009806103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral