Provider Demographics
NPI:1467587485
Name:PINE, MARTIN S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:S
Last Name:PINE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:20 PARK AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3893
Mailing Address - Country:US
Mailing Address - Phone:212-532-8494
Mailing Address - Fax:212-532-8425
Practice Address - Street 1:20 PARK AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3893
Practice Address - Country:US
Practice Address - Phone:212-532-8494
Practice Address - Fax:212-532-8425
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2018-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY109191207RA0201X
NJ25MA02573300207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY132963926OtherTAX ID
NJ1467587485OtherCOVENTRY HEALTH-FIRST HEALTH
NY323802OtherBLUE CROSS BLUE SHEILD
NJ3404949000OtherAMERIHEALTH
NJ8833753OtherCIGNA, GREATWEST
NJ1467587485OtherAMERIGROUP
NJ4316513OtherAETNA PPO
NJ4411182OtherEMBLEM HEALTH GHI
NYP571240OtherOXFORD
NJ1062082OtherWELLCARE
NJ392724OtherU.S. FAMILY HEALTH
NJ0533491Medicaid
NJ5140091OtherAETNA HMO
NYP571240OtherOXFORD
NJ392724OtherU.S. FAMILY HEALTH