Provider Demographics
NPI:1285734673
Name:HARTENDORP, PAUL AMOY (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:AMOY
Last Name:HARTENDORP
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 1:520 FRANKLIN AVENUE
Mailing Address - Street 2:SUITE 222
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530
Mailing Address - Country:US
Mailing Address - Phone:516-741-9562
Mailing Address - Fax:516-741-2381
Practice Address - Street 1:520 FRANKLIN AVENUE
Practice Address - Street 2:SUITE 222
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:516-741-9562
Practice Address - Fax:516-741-2381
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164960208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY19F541Medicare ID - Type Unspecified
NYE17607Medicare UPIN