Provider Demographics
NPI:1558639948
Name:EPSTEIN, MARTIN D (PHD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:D
Last Name:EPSTEIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 W END AVE
Mailing Address - Street 2:SUITE 1M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5503
Mailing Address - Country:US
Mailing Address - Phone:212-721-6772
Mailing Address - Fax:212-659-0697
Practice Address - Street 1:165 W END AVE
Practice Address - Street 2:SUITE 1M
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5503
Practice Address - Country:US
Practice Address - Phone:212-721-6772
Practice Address - Fax:212-659-0697
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013939103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist