Provider Demographics
NPI:1972572865
Name:ARIES, PHILIP MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:MARTIN
Last Name:ARIES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:375 E MAIN ST
Mailing Address - Street 2:SUITE 24
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706
Mailing Address - Country:US
Mailing Address - Phone:631-665-1330
Mailing Address - Fax:631-665-1363
Practice Address - Street 1:375 E MAIN ST
Practice Address - Street 2:SUITE 24
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-665-1330
Practice Address - Fax:631-665-1363
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101516207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00398870Medicaid
962181Medicare ID - Type Unspecified
NY00398870Medicaid