Healthcare Provider Details

I. General information

NPI: 1497790430
Provider Name (Legal Business Name): MARTIN S ENGELSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 EXECUTIVE PARK
ALBANY NY
12203-3718
US

IV. Provider business mailing address

PO BOX 14890
ALBANY NY
12212-4890
US

V. Phone/Fax

Practice location:
  • Phone: 518-489-7494
  • Fax: 518-489-7641
Mailing address:
  • Phone: 518-525-5634
  • Fax: 518-649-4094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number137787
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: