Provider Demographics
NPI:1104814813
Name:HART, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:HART
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 1:874 BROADWAY
Mailing Address - Street 2:APT. 601
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1222
Mailing Address - Country:US
Mailing Address - Phone:917-572-0138
Mailing Address - Fax:
Practice Address - Street 1:874 BROADWAY
Practice Address - Street 2:APT. 601
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1222
Practice Address - Country:US
Practice Address - Phone:917-572-0138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1250952080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00878620Medicaid
NY00878620Medicaid