Provider Demographics
NPI:1033971429
Name:MARTINO, LAURA J
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:MARTINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2385 STATE ROUTES 5 AND 20
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14561
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 TECHNOLOGY PKWY
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-2174
Practice Address - Country:US
Practice Address - Phone:585-354-7142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY698445163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool