Provider Demographics
NPI:1164763041
Name:MARTYNIUK, INNA (MS)
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:MARTYNIUK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 LIBERTY AVE
Mailing Address - Street 2:1 FLOOR
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2247
Mailing Address - Country:US
Mailing Address - Phone:347-466-8717
Mailing Address - Fax:
Practice Address - Street 1:453 LIBERTY AVE
Practice Address - Street 2:1 FLOOR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2247
Practice Address - Country:US
Practice Address - Phone:347-466-8717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-02
Last Update Date:2013-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY717293131174400000X
NY717241131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist