Provider Demographics
NPI:1760718357
Name:MARTIN NYDICK, P.C.
Entity Type:Organization
Organization Name:MARTIN NYDICK, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NYDICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-249-1260
Mailing Address - Street 1:475 E 72ND ST
Mailing Address - Street 2:SUITE L2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4458
Mailing Address - Country:US
Mailing Address - Phone:212-249-1260
Mailing Address - Fax:212-794-3236
Practice Address - Street 1:475 E 72ND ST
Practice Address - Street 2:SUITE L2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4458
Practice Address - Country:US
Practice Address - Phone:212-249-1260
Practice Address - Fax:212-794-3236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081732207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00118929Medicaid
NYA100019458Medicare PIN
NYB14034Medicare UPIN