Provider Demographics
NPI:1114528163
Name:LAMARTINA, PAUL J (PA-C)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:LAMARTINA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 ANNETTE DR
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1990
Mailing Address - Country:US
Mailing Address - Phone:732-895-6183
Mailing Address - Fax:
Practice Address - Street 1:1640 HIGHWAY 88 STE 201
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3068
Practice Address - Country:US
Practice Address - Phone:732-840-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00577400363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant