Provider Demographics
NPI:1356411375
Name:CHAVEZ, MARTIN R (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:R
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:700 HICKSVILLE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-3471
Mailing Address - Country:US
Mailing Address - Phone:516-576-6106
Mailing Address - Fax:516-576-5801
Practice Address - Street 1:120 MINEOLA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4064
Practice Address - Country:US
Practice Address - Phone:516-663-3010
Practice Address - Fax:516-663-3026
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2021-03-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06683400207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02961195Medicaid
NY046772Medicare PIN
NYH33875Medicare UPIN