Provider Demographics
NPI:1851817365
Name:SARAH EMILY HARTZOG
Entity Type:Organization
Organization Name:SARAH EMILY HARTZOG
Other - Org Name:EMILY HARTZOG MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTZOG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-516-5286
Mailing Address - Street 1:6528 SPRING BROOK AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-3713
Mailing Address - Country:US
Mailing Address - Phone:845-516-5286
Mailing Address - Fax:845-402-7622
Practice Address - Street 1:6528 SPRING BROOK AVE STE 1
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-3713
Practice Address - Country:US
Practice Address - Phone:845-516-5286
Practice Address - Fax:845-402-7622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169506207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty