Provider Demographics
NPI:1417249764
Name:PATTERSON, MARTHA (NP)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 STOKUM LN
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3505
Mailing Address - Country:US
Mailing Address - Phone:845-634-4974
Mailing Address - Fax:845-634-7549
Practice Address - Street 1:11 STOKUM LN
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3505
Practice Address - Country:US
Practice Address - Phone:845-634-4974
Practice Address - Fax:845-634-7549
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302609-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health