Provider Demographics
NPI:1114159423
Name:MARTIN, DANIELLE (DO)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74-03 COMMONWEALTH BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE
Mailing Address - State:NY
Mailing Address - Zip Code:11426-1150
Mailing Address - Country:US
Mailing Address - Phone:718-264-4637
Mailing Address - Fax:718-264-4886
Practice Address - Street 1:92 PONDEROSA LN
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2017
Practice Address - Country:US
Practice Address - Phone:516-302-3667
Practice Address - Fax:631-302-6658
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2547912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry