Provider Demographics
NPI:1043261266
Name:PIMENTEL, MARTHA (MD)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:PIMENTEL
Suffix:
Gender:F
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:PUTNAM PEDIATRICS
Mailing Address - Street 2:667 STONELEIGH AVENUE, SUIT 111
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512
Mailing Address - Country:US
Mailing Address - Phone:845-279-9652
Mailing Address - Fax:845-279-3606
Practice Address - Street 1:PUTNAM PEDIATRICS
Practice Address - Street 2:667 STONELEIGH AVENUE, SUIT 111
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512
Practice Address - Country:US
Practice Address - Phone:845-279-9652
Practice Address - Fax:845-279-3606
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236366208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2V8451OtherHEALTH NET
CT001347063Medicaid
CTP434110OtherOXFORD
CT1367473OtherUNITED HEALTHCARE
CT810774517OtherPHCS
CT1262509OtherAETNA US HEALTHCARE
CT7994115OtherCIGNA
F40392Medicare UPIN
CT001347063Medicaid