Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 125095 | NY |
NPI | 1104814813 |
---|---|
Provider Name | David Hart |
First Address | New York, NY 10003-1222 |
Second Address | New York, NY 10003-1222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2005 |
Last Update Date | 29/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00878620 | (05) | NY |
F53096 | (02) | NY |