Provider Demographics
NPI:1376822973
Name:ABIOYE, MARTINA OLUKEMI
Entity Type:Individual
Prefix:
First Name:MARTINA
Middle Name:OLUKEMI
Last Name:ABIOYE
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 1:423 HAMDEN AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-5148
Mailing Address - Country:US
Mailing Address - Phone:347-224-0527
Mailing Address - Fax:
Practice Address - Street 1:423 HAMDEN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-5148
Practice Address - Country:US
Practice Address - Phone:347-224-0527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285691164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse