Provider Demographics
NPI:1417434309
Name:MARTE, MANUEL JOSE
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:JOSE
Last Name:MARTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WHITTER WAY
Mailing Address - Street 2:
Mailing Address - City:GHENT
Mailing Address - State:NY
Mailing Address - Zip Code:12075-3213
Mailing Address - Country:US
Mailing Address - Phone:518-828-0800
Mailing Address - Fax:
Practice Address - Street 1:1 WHITTER WAY
Practice Address - Street 2:
Practice Address - City:GHENT
Practice Address - State:NY
Practice Address - Zip Code:12075-3213
Practice Address - Country:US
Practice Address - Phone:518-828-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027010235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist