Provider Demographics
NPI:1134252059
Name:MCGRATH, MARTIN PATRICK (DPM)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:PATRICK
Last Name:MCGRATH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 N BROADWAY STE 502
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1308
Mailing Address - Country:US
Mailing Address - Phone:914-966-0809
Mailing Address - Fax:914-966-1573
Practice Address - Street 1:984 N BROADWAY STE 502
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1308
Practice Address - Country:US
Practice Address - Phone:914-966-0809
Practice Address - Fax:914-966-1573
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004477213E00000X, 213EP1101X, 213ER0200X, 213ES0000X, 213ES0103X, 213ES0131X, 211D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No211D00000XPodiatric Medicine & Surgery Service ProvidersAssistant, Podiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01178129Medicaid
NYP00102468OtherRAIL ROAD MEDICARE
NYP5102OtherBLUCROSS BLUE SHIELD,
NYPH055OtherBLUE CROSS BLUE SHEILD
NYPH055OtherBLUE CROSS BLUE SHEILD
NYU-18039Medicare UPIN
NYP-51022Medicare ID - Type UnspecifiedNY CITY