Provider Demographics
NPI:1790943058
Name:HARDEJ, ADRIAN MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:MICHAEL
Last Name:HARDEJ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 HEMPSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-1614
Mailing Address - Country:US
Mailing Address - Phone:516-593-8808
Mailing Address - Fax:516-593-8867
Practice Address - Street 1:50 HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-1614
Practice Address - Country:US
Practice Address - Phone:516-593-8808
Practice Address - Fax:516-593-8867
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039371122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist