1063506574 NPI number — CURTIS L HARDY MD

Table of content: CURTIS L HARDY MD (NPI 1063506574)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063506574 NPI number — CURTIS L HARDY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARDY
Provider First Name:
CURTIS
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063506574
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9419 60TH AVE
Provider Second Line Business Mailing Address:
SUITE D1
Provider Business Mailing Address City Name:
ELMHURST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11373-5069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-592-5151
Provider Business Mailing Address Fax Number:
718-592-9195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9419 60TH AVE
Provider Second Line Business Practice Location Address:
SUITE D1
Provider Business Practice Location Address City Name:
ELMHURST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11373-5069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-592-5151
Provider Business Practice Location Address Fax Number:
718-592-9195
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  217592 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02108381 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01HCQR . This is a "GHI MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 244E31 . This is a "EMPIRE MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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