Provider Demographics
NPI:1235472218
Name:MARTYNOV, ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:MARTYNOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:185 RYKOWSKI LN STE 101
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-4055
Mailing Address - Country:US
Mailing Address - Phone:845-692-0030
Mailing Address - Fax:845-692-0037
Practice Address - Street 1:707 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2650
Practice Address - Country:US
Practice Address - Phone:845-692-0030
Practice Address - Fax:845-692-0037
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2984092085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology