Provider Demographics
NPI:1306210083
Name:DIAZ, MARTHA ISOLINA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:ISOLINA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 ECKFORD ST
Mailing Address - Street 2:APT. 4B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-4841
Mailing Address - Country:US
Mailing Address - Phone:646-884-2697
Mailing Address - Fax:
Practice Address - Street 1:34 ECKFORD ST
Practice Address - Street 2:APT. 4B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-4841
Practice Address - Country:US
Practice Address - Phone:646-884-2697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY-25256-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist