Provider Demographics
NPI:1598725673
Name:FERRILLO, MARTIN GERARD (DO)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:GERARD
Last Name:FERRILLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:116 EVERETT RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1427
Mailing Address - Country:US
Mailing Address - Phone:518-463-0171
Mailing Address - Fax:518-463-0174
Practice Address - Street 1:116 EVERETT RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1427
Practice Address - Country:US
Practice Address - Phone:518-463-0171
Practice Address - Fax:518-463-0174
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY237045208VP0014X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine