Healthcare Provider Details

I. General information

NPI: 1023163953
Provider Name (Legal Business Name): HARTLEY S. BANCROFT II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MIDWAY PARK DR
MIDDLETOWN NY
10940-2656
US

IV. Provider business mailing address

400 MIDWAY PARK DR
MIDDLETOWN NY
10940-2656
US

V. Phone/Fax

Practice location:
  • Phone: 845-343-0728
  • Fax: 845-343-2087
Mailing address:
  • Phone: 845-343-0728
  • Fax: 845-343-2087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number172449
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: