Basic Information
| Provider Information | |||||||||
| NPI: | 1841304805 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARTEL | ||||||||
| FirstName: | ALBERT | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 MERIDIAN CENTRE | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5854420150 | ||||||||
| FaxNumber: | 5852718704 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 MERIDIAN CENTRE | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5854420150 | ||||||||
| FaxNumber: | 5852718704 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | 2289361 | NY | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | 02496899 | 05 | NY | MEDICAID |