Provider Demographics
NPI:1194801944
Name:O'MALLEY, MARTIN J (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:J
Last Name:O'MALLEY
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 1:420 E 72ND ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4650
Mailing Address - Country:US
Mailing Address - Phone:212-203-0740
Mailing Address - Fax:
Practice Address - Street 1:420 E 72ND ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4650
Practice Address - Country:US
Practice Address - Phone:212-203-0740
Practice Address - Fax:212-203-0743
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY171306207X00000X, 207XP3100X, 207XS0114X, 207XX0004X, 207XX0005X, 207XX0801X
CT035815207X00000X, 207XP3100X, 207XS0114X, 207XX0004X, 207XX0005X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma