Provider Demographics
NPI:1437160579
Name:MARTIN, JEFFREY L (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:MARTIN
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 1:260 MIDDLE COUNTRY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787
Mailing Address - Country:US
Mailing Address - Phone:631-265-8780
Mailing Address - Fax:631-265-8521
Practice Address - Street 1:260 MIDDLE COUNTRY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787
Practice Address - Country:US
Practice Address - Phone:631-265-8780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201189207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
201189A30OtherHEALTHFIRST
0499792OtherGHI
180041248OtherRR MEDICARE
332057OtherNVA
49Z351OtherBCBS
P1126323OtherOXFORD
AA70780OtherMDNY
NY01971255Medicaid
NY8039OtherEYE MED
68921OtherGHI HMO
897893OtherMEC
S170362OtherSUFFOLK HEALTH
32741POtherHIP
6864636010OtherCIGNA
85025OtherVYTRA
2384630OtherAETNA
2C9074OtherHEALTHNET
G55139Medicare UPIN
NY01971255Medicaid