Healthcare Provider Details

I. General information

NPI: 1568884500
Provider Name (Legal Business Name): DENNY MARTIN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 09/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 BROADWAY 25TH FLOOR
NEW YORK NY
10006-3003
US

IV. Provider business mailing address

39 BROADWAY 25TH FLOOR
NEW YORK NY
10006-3003
US

V. Phone/Fax

Practice location:
  • Phone: 212-678-2676
  • Fax: 347-821-3991
Mailing address:
  • Phone: 212-395-9000
  • Fax: 347-821-3991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number255391
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number255391
License Number StateNY

VIII. Authorized Official

Name: DENNY MARTIN
Title or Position: PRESIDENT
Credential:
Phone: 212-395-9000