MEDICARE: MARTIN J NEILAN M.D.

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	207R00000X	Internal Medicine Physician	MA45085	NJ

General Provider Information

NPI Number	:	1912995853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN J NEILAN M.D.

Provider Business Mailing Address
First Line	:	516 HAMBURG TPKE
Second Line	:	SUITE 13
City	:	WAYNE
State	:	NJ
Zip	:	07470-2062
Country	:	US
Telephone Number	:	973-790-8585
Fax Number	:	973-790-1105

Provider Business Practice Location Address
First Line	:	516 HAMBURG TPKE
Second Line	:	SUITE 13
City	:	WAYNE
State	:	NJ
Zip	:	07470-2062
Country	:	US
Telephone Number	:	973-790-8585
Fax Number	:	973-790-1105

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	01/13/2010

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