Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MB28896 | NJ |
NPI | 1003817313 |
---|---|
Provider Name | Dr. Rupert Carl Hartmann |
First Address | Palmyra, NJ 08065-1802 |
Second Address | Palmyra, NJ 08065-1802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 24/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1857606 | (05) | NJ |
E06157 | (02) | NJ |