MEDICARE: DR. BERNARD F. MARTIN III DPM

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	213E00000X	Podiatrist	N003584-1	NY

General Provider Information

NPI Number	:	1790783363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERNARD F. MARTIN III DPM

Provider Business Mailing Address
First Line	:	66-60 80TH STREET
Second Line	:
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379
Country	:	US
Telephone Number	:	718-326-1815
Fax Number	:	718-326-7770

Provider Business Practice Location Address
First Line	:	66-60 80TH STREET
Second Line	:
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379
Country	:	US
Telephone Number	:	718-326-1815
Fax Number	:	718-326-7770

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	07/08/2007

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