Provider Demographics
NPI:1609841725
Name:MARTIN, BARBARA ANDREA (CNM)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:ANDREA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 ALVIN TER
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1401
Mailing Address - Country:US
Mailing Address - Phone:973-467-3292
Mailing Address - Fax:
Practice Address - Street 1:606 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1936
Practice Address - Country:US
Practice Address - Phone:973-674-4343
Practice Address - Fax:973-674-5581
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO0694800367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ146-9002Medicaid