Healthcare Provider Details

I. General information

NPI: 1245211416
Provider Name (Legal Business Name): MAURICE JOSEPH MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 MADISON AVE
NEW YORK NY
10035-3832
US

IV. Provider business mailing address

245 E 21ST ST APT 14A
NEW YORK NY
10010-6412
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-4500
  • Fax:
Mailing address:
  • Phone: 617-838-5587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number286047
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: