Healthcare Provider Details

I. General information

NPI: 1053670745
Provider Name (Legal Business Name): ZACHARY HART D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 HARRISON AVE STE 206
MAMARONECK NY
10543-3150
US

IV. Provider business mailing address

1600 HARRISON AVE STE 206
MAMARONECK NY
10543-3150
US

V. Phone/Fax

Practice location:
  • Phone: 914-698-2025
  • Fax: 914-698-1276
Mailing address:
  • Phone: 914-698-2025
  • Fax: 914-698-1276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN006749
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2173290
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: