Healthcare Provider Details

I. General information

NPI: 1134252059
Provider Name (Legal Business Name): MARTIN PATRICK MCGRATH DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 06/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

984 N BROADWAY STE 502
YONKERS NY
10701-1308
US

IV. Provider business mailing address

984 N BROADWAY STE 502
YONKERS NY
10701-1308
US

V. Phone/Fax

Practice location:
  • Phone: 914-966-0809
  • Fax: 914-966-1573
Mailing address:
  • Phone: 914-966-0809
  • Fax: 914-966-1573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code211D00000X
TaxonomyPodiatric Assistant
License NumberN004477
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN004477
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberN004477
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License NumberN004477
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberN004477
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN004477
License Number StateNY
# 7
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN004477
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: