Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 25MA06683400 | NJ |
NPI | 1356411375 |
---|---|
Provider Name | Dr. Martin R Chavez |
First Address | Bethpage, NY 11714-3471 |
Second Address | Mineola, NY 11501-4064 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 08/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02961195 | (05) | NY |
H33875 | (02) | NY |