Provider Demographics
NPI:1487944807
Name:HARTZ, JESSICA ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:HARTZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1991 MARCUS AVE STE M100
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-2062
Mailing Address - Country:US
Mailing Address - Phone:516-472-3750
Mailing Address - Fax:516-472-3751
Practice Address - Street 1:1991 MARCUS AVE STE M100
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2062
Practice Address - Country:US
Practice Address - Phone:516-472-3750
Practice Address - Fax:516-472-3751
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054780363AM0700X
NY026301363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical