Healthcare Provider Details

I. General information

NPI: 1427237478
Provider Name (Legal Business Name): MONICA C MARTIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 MADISON AVE SUITE 11
NEW YORK NY
10016
US

IV. Provider business mailing address

401 W 56TH ST SUITE 4E
NEW YORK NY
10019-3611
US

V. Phone/Fax

Practice location:
  • Phone: 212-213-5811
  • Fax:
Mailing address:
  • Phone: 212-213-5811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number148324
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: