Provider Demographics
NPI:1831252006
Name:MAYER, MARTIN (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:MAYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 ST. GEORGES AVE.
Mailing Address - Street 2:SUITE 105
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-3427
Mailing Address - Country:US
Mailing Address - Phone:732-382-1300
Mailing Address - Fax:732-382-4045
Practice Address - Street 1:1503 ST. GEORGES AVE.
Practice Address - Street 2:SUITE 105
Practice Address - City:COLONIA
Practice Address - State:NJ
Practice Address - Zip Code:07067-3427
Practice Address - Country:US
Practice Address - Phone:732-382-1300
Practice Address - Fax:732-382-4045
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA00333242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0446602-01Medicaid
NJMA0033324OtherMEDICAL LICENSE
NJMA44590Medicare ID - Type Unspecified
NJMA0033324OtherMEDICAL LICENSE