Provider Demographics
NPI:1639178023
Name:ENGELHARDT, MARTIN B III (DO)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:B
Last Name:ENGELHARDT
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333A NORTH AVE
Mailing Address - Street 2:PMB 436
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-2120
Mailing Address - Country:US
Mailing Address - Phone:914-233-5822
Mailing Address - Fax:
Practice Address - Street 1:77 QUAKER RIDGE RD
Practice Address - Street 2:SUITE 200A
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-2808
Practice Address - Country:US
Practice Address - Phone:914-235-8224
Practice Address - Fax:914-235-6940
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205777207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01563395Medicaid
NYG70511Medicare UPIN
NY79595ZT7R1Medicare PIN