Provider Demographics
NPI:1538224225
Name:MARTIN P. SHERMAN M.D.P.C.
Entity type:Organization
Organization Name:MARTIN P. SHERMAN M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-598-2211
Mailing Address - Street 1:193 BROADWAY
Mailing Address - Street 2:BOX 568
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2761
Mailing Address - Country:US
Mailing Address - Phone:631-598-2211
Mailing Address - Fax:631-691-2310
Practice Address - Street 1:193 BROADWAY
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2761
Practice Address - Country:US
Practice Address - Phone:631-598-2211
Practice Address - Fax:631-691-2310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-24
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128233207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00770338Medicaid
NY00770338Medicaid
NYWZPZW1Medicare PIN