MEDICARE: DR. WILLIAM HENRY HARTWIG PH.D.

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	103G00000X	Clinical Neuropsychologist	006984	NY
2	103TC0700X	Clinical Psychologist	006984	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770502346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM HENRY HARTWIG PH.D.

Provider Business Mailing Address
First Line	:	12 DAVIS AVE 2N
Second Line	:
City	:	POUGHKEEPSIE
State	:	NY
Zip	:	12603-2453
Country	:	US
Telephone Number	:	845-471-8175
Fax Number	:	845-471-0139

Provider Business Practice Location Address
First Line	:	12 DAVIS AVE
Second Line	:
City	:	POUGHKEEPSIE
State	:	NY
Zip	:	12603-2408
Country	:	US
Telephone Number	:	845-471-8175
Fax Number	:

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/24/2017

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