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NPI Code Detail

MEDICARE: EMMANUEL M MARTAKIS MD

MEDICARE: EMMANUEL M MARTAKIS 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
1208000000XPediatrics Physician238463NY
2208000000XPediatrics PhysicianMD429082PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1609826023
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMMANUEL M MARTAKIS MD
Provider Business Mailing Address
First Line : PO BOX 987
Second Line : 21 ORCHARD STREET
City : MIDDLETOWN
State : NY
Zip : 10940-5004
Country : US
Telephone Number : 845-343-7614
Fax Number : 845-343-5390
Provider Business Practice Location Address
First Line : 140 HAMMOND STREET
Second Line :
City : PORT JERVIS
State : NY
Zip : 12771-2607
Country : US
Telephone Number : 845-858-2854
Fax Number : 845-343-5390
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2006
Last Update Date : 08/06/2012

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