Healthcare Provider Details

I. General information

NPI: 1649241530
Provider Name (Legal Business Name): MARTIN NASH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY COLUMBIA UNIVERSITY DEPARTMENT PEDIATRICS
NEW YORK NY
10032
US

IV. Provider business mailing address

959 PELHAMDALE AVE
PELHAM NY
10803-2924
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-7250
  • Fax: 212-544-1974
Mailing address:
  • Phone: 314-738-3046
  • Fax: 212-544-1974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number97783
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: