Provider Demographics
NPI:1013230986
Name:MARTELLY, YVANNE D (BS)
Entity Type:Individual
Prefix:
First Name:YVANNE
Middle Name:D
Last Name:MARTELLY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:MARIE YVANNE
Other - Middle Name:D
Other - Last Name:MARTELLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS
Mailing Address - Street 1:100 WARWICK RD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1429
Mailing Address - Country:US
Mailing Address - Phone:516-448-2110
Mailing Address - Fax:
Practice Address - Street 1:10002 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2748
Practice Address - Country:US
Practice Address - Phone:718-520-2334
Practice Address - Fax:718-268-9680
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist