Provider Demographics
NPI:1467850966
Name:MARTIN, GISELLE LORENA (DC)
Entity Type:Individual
Prefix:DR
First Name:GISELLE
Middle Name:LORENA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3256 STEINWAY ST STE B
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-4006
Mailing Address - Country:US
Mailing Address - Phone:718-278-0734
Mailing Address - Fax:
Practice Address - Street 1:3256 STEINWAY ST
Practice Address - Street 2:SUITE B
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-4006
Practice Address - Country:US
Practice Address - Phone:718-619-8913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-15
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012608-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor