Basic Information
| Provider Information | |||||||||
| NPI: | 1942299128 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANTMAN | ||||||||
| FirstName: | STUART | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2263 S CLINTON AVE | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146182623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852416400 | ||||||||
| FaxNumber: | 5852416505 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 LATTIMORE RD | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146204159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852416400 | ||||||||
| FaxNumber: | 5852416505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2005 | ||||||||
| LastUpdateDate: | 12/09/2013 | ||||||||
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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 | 2085R0202X | 124087 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 00580685 | 05 | NY | MEDICAID |