Healthcare Provider Details

I. General information

NPI: 1780908673
Provider Name (Legal Business Name): MARTIN ARTHUR HAUPTMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2010
Last Update Date: 03/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TIDE MILL RD
SAINT JAMES NY
11780-9626
US

IV. Provider business mailing address

1 TIDE MILL RD
SAINT JAMES NY
11780-9626
US

V. Phone/Fax

Practice location:
  • Phone: 631-265-3174
  • Fax: 631-265-9084
Mailing address:
  • Phone: 631-265-3174
  • Fax: 631-265-9084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number092331
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: