Provider Demographics
NPI:1477676435
Name:DINER, MARTIN K (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:K
Last Name:DINER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 STEUBEN AVE
Mailing Address - Street 2:
Mailing Address - City:TAPPAN
Mailing Address - State:NY
Mailing Address - Zip Code:10983-1917
Mailing Address - Country:US
Mailing Address - Phone:845-359-1800
Mailing Address - Fax:
Practice Address - Street 1:42 STEUBEN AVE
Practice Address - Street 2:
Practice Address - City:TAPPAN
Practice Address - State:NY
Practice Address - Zip Code:10983-1917
Practice Address - Country:US
Practice Address - Phone:845-359-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3504103T00000X
NY1806352083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine