1770546947 NPI number — DR. SARAH EMILY HARTZOG I MD

Table of content: DR. SARAH EMILY HARTZOG I MD (NPI 1770546947)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770546947 NPI number — DR. SARAH EMILY HARTZOG I MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARTZOG
Provider First Name:
SARAH
Provider Middle Name:
EMILY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
I
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1770546947
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
245 5TH AVE
Provider Second Line Business Mailing Address:
THE CONTINUUM CENTER FOR HEALTH AND HEALING
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10016-8728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-935-2259
Provider Business Mailing Address Fax Number:
646-935-2273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 5TH AVE
Provider Second Line Business Practice Location Address:
THE CONTINUUM CENTER FOR HEALTH AND HEALING
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016-8728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-935-2244
Provider Business Practice Location Address Fax Number:
646-935-2273
Provider Enumeration Date:
04/10/2006

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: 207V00000X , with the licence number:  169506-1 , 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: 33507 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: TL30522 . This is a "STATE LICENSE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 48439401200001 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 01335074 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4843940-8905 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 38745 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com