MEDICARE: GERDA HARTL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	25MA02530500	NJ
2	2084P0800X	Psychiatry Physician	25MA02530500	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235391848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERDA HARTL M.D.

Provider Business Mailing Address
First Line	:	4 HORIZON RD.
Second Line	:	APT. G-05
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6716
Country	:	US
Telephone Number	:	201-224-0776
Fax Number	:	201-224-0776

Provider Business Practice Location Address
First Line	:	4 HORIZON RD.
Second Line	:	APT. G-05
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6716
Country	:	US
Telephone Number	:	201-224-0776
Fax Number	:	201-224-0776

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	07/21/2009

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