Provider Demographics
NPI:1881626125
Name:HARTSDALE MEDICAL GROUP PC
Entity type:Organization
Organization Name:HARTSDALE MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXWELL
Authorized Official - Middle Name:MANI
Authorized Official - Last Name:CHAIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-725-2010
Mailing Address - Street 1:180 E HARTSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-3544
Mailing Address - Country:US
Mailing Address - Phone:914-725-2010
Mailing Address - Fax:914-725-6488
Practice Address - Street 1:180 E HARTSDALE AVE
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-3544
Practice Address - Country:US
Practice Address - Phone:914-725-2010
Practice Address - Fax:914-725-6488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00599720Medicaid
NY02702743Medicaid
NY00599748Medicaid
NY01365764Medicaid
NY00599615Medicaid
NYBM016L4410Medicare ID - Type UnspecifiedBENJAMIN J MARANO
NY01365764Medicaid
NYD60156Medicare UPIN
NY00599720Medicaid
NY02702743Medicaid
NY00599748Medicaid
NYB16194Medicare UPIN
NYSV035S5310Medicare ID - Type UnspecifiedSTEVEN L VALENSTEIN
NYLC01640810Medicare ID - Type UnspecifiedLEO R CARDILLO
NYHM0W5L0810Medicare ID - Type UnspecifiedHARTSDALE MEDICAL GROUP P
NY00599615Medicaid