Provider Demographics
NPI:1598987919
Name:CEDARHOLM, MARTHA AMY (NP)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:AMY
Last Name:CEDARHOLM
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 1:601 E 19TH ST
Mailing Address - Street 2:APT 1G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-7358
Mailing Address - Country:US
Mailing Address - Phone:347-756-3497
Mailing Address - Fax:
Practice Address - Street 1:215 WILLOUGHBY AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-3818
Practice Address - Country:US
Practice Address - Phone:718-399-4542
Practice Address - Fax:718-399-4544
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332185363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily