Healthcare Provider Details

I. General information

NPI: 1174606693
Provider Name (Legal Business Name): ELIZABETH VIRGINIA HARTMAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2006
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 HIX AVE
RYE NY
10580-2450
US

IV. Provider business mailing address

92 HIX AVE
RYE NY
10580-2450
US

V. Phone/Fax

Practice location:
  • Phone: 914-315-7015
  • Fax: 914-305-6354
Mailing address:
  • Phone: 914-315-7015
  • Fax: 914-305-6354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number216220
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: