Provider Demographics
NPI:1801849146
Name:HARTFORD PHYSICIAN'S MANAGEMENT CORP.
Entity Type:Organization
Organization Name:HARTFORD PHYSICIAN'S MANAGEMENT CORP.
Other - Org Name:HARTFORD GYN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZARUS
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:856-356-4000
Mailing Address - Street 1:601 CHAPEL AVE E
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1407
Mailing Address - Country:US
Mailing Address - Phone:856-356-4025
Mailing Address - Fax:856-356-4038
Practice Address - Street 1:1 MAIN ST
Practice Address - Street 2:UNIT N1
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-1806
Practice Address - Country:US
Practice Address - Phone:860-525-1900
Practice Address - Fax:860-522-9913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0009261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004137552Medicaid