Provider Demographics
NPI:1144237421
Name:WERTKIN, MARTIN GARY (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:GARY
Last Name:WERTKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:1034 N BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1303
Practice Address - Country:US
Practice Address - Phone:914-965-2026
Practice Address - Fax:914-965-1499
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116387208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY116387-A85OtherHEALTH FIRST
NY701744OtherUS FAMILY HEALTH PLAN
NY000000014863OtherGHI HMO
NY120727000113OtherFIDELIS CARE
NY187TM1OtherEMPIRE BCBS
NY000000014863OtherHIP
NYDOC067154OtherVNS CHOICE
NYPRIS# 2920539OtherHIP
NYP01084439OtherRAILROAD MEDICARE
NYPPO ID# 0085762OtherHIP
NY0465157OtherCIGNA
NY116387Other1199 NATIONAL BENEFIT FUND
NY2671201OtherGHI PPO
NYP4570623OtherOXFORD PLAN THRU UNITED HEALTHCARE
NY001814OtherCONNECTICARE THRU MFHA, IPA
NY00369599Medicaid
NY201235200020OtherAFFINITY HEALTH PLAN
NY4096851OtherAETNA
NYB13341Medicare UPIN
NY00369599Medicaid
NY000000014863OtherGHI HMO