Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 218643 | NY |
NPI | 1043236623 |
---|---|
Provider Name | Dr. Roger Hartl |
First Address | New York, NY 10065 |
Second Address | New York, NY 10065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 15/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02599746 | (05) | NY |