Provider Demographics
NPI:1093723710
Name:TAYLOR, MARTHA W (CNS)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:W
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-2409
Mailing Address - Country:US
Mailing Address - Phone:516-221-8924
Mailing Address - Fax:516-783-8246
Practice Address - Street 1:108 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-2409
Practice Address - Country:US
Practice Address - Phone:516-221-8924
Practice Address - Fax:516-783-8246
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305202364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
076750OtherVALUE OPTIONS
190611OtherMHN
305202-A27OtherHEALTH FIRST
032097OtherCNS
2734122OtherCIGNA
7493800OtherGHI
54361OtherUNITED BEHAVIORAL HEALTH
NY03187139Medicaid
4633877OtherAETNA
29936OtherANTHEM
080860000OtherMAGELLAN
190611OtherMHN
NYR08851Medicare PIN