Provider Demographics
NPI:1164485025
Name:MAN, MARTIN (DMD,)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:MAN
Suffix:
Gender:M
Credentials:DMD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 PARK ROW
Mailing Address - Street 2:SUITE 6
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-5000
Mailing Address - Country:US
Mailing Address - Phone:212-962-1305
Mailing Address - Fax:347-983-7240
Practice Address - Street 1:185 PARK ROW
Practice Address - Street 2:SUITE 6
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-5000
Practice Address - Country:US
Practice Address - Phone:212-962-1305
Practice Address - Fax:212-964-3114
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0396081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice