Provider Demographics
NPI:1518022367
Name:WILNER, MARTIN THEODORE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:THEODORE
Last Name:WILNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:60 E 66TH ST
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-6540
Mailing Address - Country:US
Mailing Address - Phone:212-288-9700
Mailing Address - Fax:212-288-3421
Practice Address - Street 1:60 E 66TH ST
Practice Address - Street 2:SUITE 3A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-6540
Practice Address - Country:US
Practice Address - Phone:212-288-9700
Practice Address - Fax:212-288-3421
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1667662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE87248Medicare UPIN
NY28F911Medicare ID - Type Unspecified