Provider Demographics
NPI:1437282563
Name:MARTINO PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:MARTINO PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:F
Authorized Official - Last Name:MARTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-880-7900
Mailing Address - Street 1:1150 PORTION RD
Mailing Address - Street 2:STE 3
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742
Mailing Address - Country:US
Mailing Address - Phone:631-880-7900
Mailing Address - Fax:631-880-7899
Practice Address - Street 1:1150 PORTION RD
Practice Address - Street 2:STE 3
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742
Practice Address - Country:US
Practice Address - Phone:631-880-7900
Practice Address - Fax:631-880-7899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQBWRQ1Medicare PIN