Provider Demographics
NPI:1053422824
Name:HARTMAN, FREDRIC CHARLES (PHD)
Entity type:Individual
Prefix:
First Name:FREDRIC
Middle Name:CHARLES
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:EAST WILLISTON
Mailing Address - State:NY
Mailing Address - Zip Code:11596-1916
Mailing Address - Country:US
Mailing Address - Phone:516-746-2487
Mailing Address - Fax:516-294-4810
Practice Address - Street 1:436 WILLIS AVE
Practice Address - Street 2:4
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-2240
Practice Address - Country:US
Practice Address - Phone:516-746-2487
Practice Address - Fax:516-294-4810
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009350-1103TC0700X, 103T00000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV67791Medicare ID - Type Unspecified