Provider Demographics
NPI:1982828885
Name:HARTZ, JAY MARVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:MARVIN
Last Name:HARTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1866 SCARLET OAK TRL
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-8874
Mailing Address - Country:US
Mailing Address - Phone:920-303-2729
Mailing Address - Fax:920-237-3183
Practice Address - Street 1:1866 SCARLET OAK TRL
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-8874
Practice Address - Country:US
Practice Address - Phone:920-303-2729
Practice Address - Fax:920-237-3183
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI700292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31863200Medicaid
WI31863200Medicaid