Provider Demographics
NPI:1174399596
Name:JEFFREY D. HART DO PC
Entity type:Organization
Organization Name:JEFFREY D. HART DO PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-459-4671
Mailing Address - Street 1:4200 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5311
Mailing Address - Country:US
Mailing Address - Phone:833-374-2787
Mailing Address - Fax:
Practice Address - Street 1:4200 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5311
Practice Address - Country:US
Practice Address - Phone:833-374-2787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEFFREY D. HART DO PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-27
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1871685404OtherNPI
NY1386680023OtherNPI
NY1235844606OtherNPI
NY1386801579OtherNPI