Basic Information
| Provider Information | |||||||||
| NPI: | 1710145859 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MCATEER | ||||||||
| OtherFirstName: | REBECCA | ||||||||
| OtherMiddleName: | A | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 165 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | OSSINING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105624702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149411263 | ||||||||
| FaxNumber: | 9149418626 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 N BROADWAY | ||||||||
| Address2: | |||||||||
| City: | SLEEPY HOLLOW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105912370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146314141 | ||||||||
| FaxNumber: | 9146311867 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2008 | ||||||||
| LastUpdateDate: | 06/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD442812 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | MD040556 | DC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | MD040556 | DC | N | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | 284080 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0466859 | 05 | NY | MEDICAID |