Provider Demographics
NPI:1275092512
Name:MOMANYI, MARTHA K
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:K
Last Name:MOMANYI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4321
Mailing Address - Country:US
Mailing Address - Phone:201-915-2000
Mailing Address - Fax:
Practice Address - Street 1:208 E ELIZABETH AVE APT A2A
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-3078
Practice Address - Country:US
Practice Address - Phone:973-932-7326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-17
Last Update Date:2019-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR14511400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily