Provider Demographics
NPI:1417137928
Name:MAMOS, MARTA M (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARTA
Middle Name:M
Last Name:MAMOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:119 W 57TH ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2303
Mailing Address - Country:US
Mailing Address - Phone:212-421-1740
Mailing Address - Fax:212-421-1750
Practice Address - Street 1:119 W 57TH ST
Practice Address - Street 2:SUITE 212
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2303
Practice Address - Country:US
Practice Address - Phone:212-421-1740
Practice Address - Fax:212-421-1750
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY029033-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400028943Medicare PIN