Provider Demographics
NPI:1477629301
Name:LURIA, MARTIN JAY (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:JAY
Last Name:LURIA
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 1:170 MORRIS AVENUE
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740
Mailing Address - Country:US
Mailing Address - Phone:732-222-8874
Mailing Address - Fax:732-222-8584
Practice Address - Street 1:170 MORRIS AVENUE
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740
Practice Address - Country:US
Practice Address - Phone:732-222-8874
Practice Address - Fax:732-222-8584
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2013-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03151900207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2970406Medicaid
047099Medicare ID - Type Unspecified
NJ2970406Medicaid