Provider Demographics
NPI:1205192374
Name:MARTIN, MONICA DOREEN (RN)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:DOREEN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11625 GUY R BREWER BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-1614
Mailing Address - Country:US
Mailing Address - Phone:718-977-4800
Mailing Address - Fax:718-977-4802
Practice Address - Street 1:116-25 GUY R. BREWER BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-1614
Practice Address - Country:US
Practice Address - Phone:718-977-4800
Practice Address - Fax:718-977-4802
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4326461163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse