MEDICARE: MRS. ITTA R HARTMAN MSED

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	174400000X	Specialist
2	103K00000X	Behavior Analyst	001015	NY

General Provider Information

NPI Number	:	1689939407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ITTA R HARTMAN MSED

Provider Business Mailing Address
First Line	:	1526 E. 37TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234
Country	:	US
Telephone Number	:	718-677-3005
Fax Number	:

Provider Business Practice Location Address
First Line	:	1526 E 37TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3418
Country	:	US
Telephone Number	:	718-677-3005
Fax Number	:

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

Provider Enumeration Date	:	07/09/2012
Last Update Date	:	09/11/2024

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