Provider Demographics
NPI:1396703906
Name:HARTONO, CHOLI (MD)
Entity type:Individual
Prefix:
First Name:CHOLI
Middle Name:
Last Name:HARTONO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:504-506 EAST 74TH STREET
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3486
Mailing Address - Country:US
Mailing Address - Phone:212-249-4061
Mailing Address - Fax:
Practice Address - Street 1:20 PROSPECT AVE STE 406
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1941
Practice Address - Country:US
Practice Address - Phone:551-996-2608
Practice Address - Fax:551-996-0826
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA227574207RN0300X
NY212801207RN0300X
NJ25MA12080600207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology