Provider Demographics
NPI:1164551438
Name:MARTINO, ANDREW F (PT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:F
Last Name:MARTINO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SEABROOK LN
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-3323
Mailing Address - Country:US
Mailing Address - Phone:631-689-2171
Mailing Address - Fax:
Practice Address - Street 1:1150 PORTION RD STE 3
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1074
Practice Address - Country:US
Practice Address - Phone:631-880-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011821225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ259DQBRQ1Medicare PIN