Provider Demographics
NPI:1306997648
Name:WININGER, MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:WININGER
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 1:8037 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-3160
Mailing Address - Country:US
Mailing Address - Phone:718-898-8600
Mailing Address - Fax:718-898-8704
Practice Address - Street 1:8037 BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3160
Practice Address - Country:US
Practice Address - Phone:718-898-8600
Practice Address - Fax:718-898-8704
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094866207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00956336Medicaid
NY76470HMedicare ID - Type Unspecified
NYB16034Medicare UPIN