1700896131 NPI number — WILLIAM MARTIN M.D.

Table of content: WILLIAM MARTIN M.D. (NPI 1700896131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700896131 NPI number — WILLIAM MARTIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
WILLIAM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700896131
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325 PARK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11743-2779
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-351-3758
Provider Business Mailing Address Fax Number:
631-351-3712

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11743-2779
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-351-3758
Provider Business Practice Location Address Fax Number:
631-351-3712
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  168911-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01340252 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20813 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: CS274 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2C4864 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 53K241 . This is a "BLUE CROSS/ BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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