Provider Demographics
NPI:1528227857
Name:MARTINO, LINDSAY (PA)
Entity Type:Individual
Prefix:MS
First Name:LINDSAY
Middle Name:
Last Name:MARTINO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SEAVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3419
Mailing Address - Country:US
Mailing Address - Phone:718-226-4940
Mailing Address - Fax:718-226-4945
Practice Address - Street 1:501 SEAVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3419
Practice Address - Country:US
Practice Address - Phone:718-226-4940
Practice Address - Fax:718-226-4945
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY012942363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program