Provider Demographics
NPI:1134250798
Name:SHERMAN, MARTIN PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:PAUL
Last Name:SHERMAN
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 1:193 BROADWAY
Mailing Address - Street 2:BOX 568
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2761
Mailing Address - Country:US
Mailing Address - Phone:631-598-2211
Mailing Address - Fax:631-691-2310
Practice Address - Street 1:193 BROADWAY
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2761
Practice Address - Country:US
Practice Address - Phone:631-598-2211
Practice Address - Fax:631-691-2310
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128233207N00000X, 207NS0135X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00770338Medicaid
NY00770338Medicaid
NY84A16ZPZW1Medicare PIN