Provider Demographics
NPI:1699546705
Name:HARTMANN, ZOE DEE (PA-C)
Entity type:Individual
Prefix:
First Name:ZOE
Middle Name:DEE
Last Name:HARTMANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-2817
Mailing Address - Country:US
Mailing Address - Phone:734-353-2855
Mailing Address - Fax:
Practice Address - Street 1:5530 SHERIDAN DR STE 2
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14221-3730
Practice Address - Country:US
Practice Address - Phone:716-656-1978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031121363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty