MEDICARE: DR. MARTIN A DESMERY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	093164-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MD93164	OTHER	NY	NONE

General Provider Information

NPI Number	:	1003143975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN A DESMERY MD

Provider Business Mailing Address
First Line	:	1428 OLD FORD RD
Second Line	:
City	:	NEW PALTZ
State	:	NY
Zip	:	12561-2660
Country	:	US
Telephone Number	:	845-255-7758
Fax Number	:

Provider Business Practice Location Address
First Line	:	1428 OLD FORD RD
Second Line	:
City	:	NEW PALTZ
State	:	NY
Zip	:	12561-2660
Country	:	US
Telephone Number	:	845-255-7758
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2009
Last Update Date	:	11/12/2009

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Directions to “ DR. MARTIN A DESMERY MD” Practice Location

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