Provider Demographics
NPI:1265424337
Name:HARTMAN, ERIC JESSE (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JESSE
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-2902
Mailing Address - Country:US
Mailing Address - Phone:609-265-9363
Mailing Address - Fax:609-265-9424
Practice Address - Street 1:200 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-2902
Practice Address - Country:US
Practice Address - Phone:609-265-9363
Practice Address - Fax:609-265-9424
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2008-09-23
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
NJMA064158207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG28991Medicare UPIN
NJ4644190001Medicare NSC
NJ874611Medicare PIN