NPI |
1679197487 |
The middle name of the provider, if the provider
is an individual. |
Entity Type Code |
1 |
The name prefix or salutation of the provider
if the provider is an individual; for example, Mr., Mrs., or Corporal. |
Provider Last Name Legal Name |
HARTSTEIN |
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider First Name |
GEORGE |
The first name of the provider, if the provider
is an individual. |
Provider Middle Name |
LUKE |
The middle name of the provider, if the provider
is an individual. |
Provider First Line Business Practice Location Address |
330 BROOKLINE AVE |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
BOSTON |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
MA |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
022155400 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
6176674735 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Enumeration Date |
6/8/2020 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
6/8/2020 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Gender Code |
M |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Taxonomy Code 1 |
390200000X |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Sole Proprietor |
N |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
NPI Certification Date |
6/8/2020 |
|