1235391848 NPI number — GERDA HARTL M.D.

Table of content: GERDA HARTL M.D. (NPI 1235391848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235391848 NPI number — GERDA HARTL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARTL
Provider First Name:
GERDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STRIKA
Provider Other First Name:
GERDA
Provider Other Middle Name:
HARTL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235391848
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 HORIZON RD.
Provider Second Line Business Mailing Address:
APT. G-05
Provider Business Mailing Address City Name:
FORT LEE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07024-6716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-224-0776
Provider Business Mailing Address Fax Number:
201-224-0776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 HORIZON RD.
Provider Second Line Business Practice Location Address:
APT. G-05
Provider Business Practice Location Address City Name:
FORT LEE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07024-6716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-224-0776
Provider Business Practice Location Address Fax Number:
201-224-0776
Provider Enumeration Date:
06/26/2008

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: 2084P0804X , with the licence number:  25MA02530500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X , with the licence number: 25MA02530500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 6256309 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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