Basic Information
Provider Information
NPI: 1336128198
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MARTIMUCCI
FirstName: WILLIAM
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 210 WESTCHESTER AVE
Address2: 3RD FLOOR
City: WHITE PLAINS
State: NY
PostalCode: 106042901
CountryCode: US
TelephoneNumber: 9146813146
FaxNumber: 9146826403
Practice Location
Address1: 1 THEALL RD
Address2:  
City: RYE
State: NY
PostalCode: 105801404
CountryCode: US
TelephoneNumber: 9148488700
FaxNumber: 9146826403
Other Information
ProviderEnumerationDate: 01/11/2006
LastUpdateDate: 10/16/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RG0300X177089NYY Allopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
207RG0300X036100CTN Allopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine

No ID Information.


Home