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General NPI Number Information
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NPI Number | 1366575029
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Entity Type | Individual
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Provider Name | MARTIN J BOLTON PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 07/08/2014
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Provider Practice Location Address
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Address Line | 760 BROADWAY WOODHULL MENTAL & MEDICAL HEALTH CENTER
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City | BROOKLYN
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State | NY
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Zip | 11206
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Country | US
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Telephone | 718-963-8000
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Fax | 718-260-7507
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Provider Business Mailing Address
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Address Line | 760 BROADWAY DEPARTMENT OF MANAGED CARE ROOM 2B230 WOODHULL MENTAL & MEDICAL HEALTH CENTER
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City | BROOKLYN
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State | NY
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Zip | 11206
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Country | US
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Telephone | 718-963-8000
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Fax | 718-630-3122
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6887-1
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License Number State | NY
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