Provider Demographics
NPI:1427065044
Name:COLTON, MARTIN JAY (DDS,MS)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JAY
Last Name:COLTON
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E ECKERSON RD
Mailing Address - Street 2:240
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-7153
Mailing Address - Country:US
Mailing Address - Phone:845-352-0520
Mailing Address - Fax:845-352-0566
Practice Address - Street 1:200 E ECKERSON RD
Practice Address - Street 2:240
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-7153
Practice Address - Country:US
Practice Address - Phone:845-352-0520
Practice Address - Fax:845-352-0566
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0214051223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00507699Medicaid