Provider Demographics
NPI:1780640987
Name:MARTIN, DEAN (MD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 DAVIDSON AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-4153
Mailing Address - Country:US
Mailing Address - Phone:732-271-1400
Mailing Address - Fax:732-271-3544
Practice Address - Street 1:285 DAVIDSON AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-4153
Practice Address - Country:US
Practice Address - Phone:732-271-1400
Practice Address - Fax:732-271-3544
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA681106207L00000X
NJ25MA06811000207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8768200Medicaid
NJ020503Medicare ID - Type UnspecifiedPROVIDER #
NJ8768200Medicaid