Provider Demographics
NPI:1467571067
Name:MARTINEZ, NATHALIE B (NP)
Entity Type:Individual
Prefix:
First Name:NATHALIE
Middle Name:B
Last Name:MARTINEZ
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 1:100 NICOLLS RD # T16-080
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8167
Mailing Address - Country:US
Mailing Address - Phone:631-444-1066
Mailing Address - Fax:631-444-1054
Practice Address - Street 1:676 COUNTY ROAD 39A
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-5241
Practice Address - Country:US
Practice Address - Phone:631-702-8327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY469900163W00000X
NYF303624363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ67397Medicare UPIN
NY1628G1Medicare ID - Type Unspecified