MEDICARE: SARAH EMILY HARTZOG

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	207V00000X	Obstetrics & Gynecology Physician	169506	NY

General Provider Information

NPI Number	:	1851817365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARAH EMILY HARTZOG

Provider Business Mailing Address
First Line	:	6528 SPRING BROOK AVE STE 1
Second Line	:
City	:	RHINEBECK
State	:	NY
Zip	:	12572-3713
Country	:	US
Telephone Number	:	845-516-5286
Fax Number	:	845-402-7622

Provider Business Practice Location Address
First Line	:	6528 SPRING BROOK AVE STE 1
Second Line	:
City	:	RHINEBECK
State	:	NY
Zip	:	12572-3713
Country	:	US
Telephone Number	:	845-516-5286
Fax Number	:	845-402-7622

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	EMILY HARTZOG
Credential	:	MD
Telephone Number	:	845-516-5286

Provider Enumeration Date	:	08/16/2017
Last Update Date	:	07/21/2022

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