Provider Demographics
NPI:1811940042
Name:KABACK, MARTIN B (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:B
Last Name:KABACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-0115
Mailing Address - Country:US
Mailing Address - Phone:518-475-7300
Mailing Address - Fax:518-475-9174
Practice Address - Street 1:1240 NEW SCOTLAND RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-9222
Practice Address - Country:US
Practice Address - Phone:518-475-7300
Practice Address - Fax:518-475-9174
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY165031207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0061268OtherGHI
NYMK044Z6810OtherBLUE CROSS
NY000407001002OtherBLUE SHIELD NENY
NY040920000001OtherFIDELIS
NY10000997OtherCDPHP
NY350872OtherMVP
NY00940294Medicaid
VT1001807Medicaid
NY47437OtherGHI HMO
NY00940294Medicaid
VT1001807Medicaid