Provider Demographics
NPI:1629281878
Name:MARTIN'S YOUTH SERVICES
Entity Type:Organization
Organization Name:MARTIN'S YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAHIRA
Authorized Official - Middle Name:ZAKIA
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-227-1898
Mailing Address - Street 1:901 ROUTE 168 STE 208
Mailing Address - Street 2:
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-3203
Mailing Address - Country:US
Mailing Address - Phone:856-227-1898
Mailing Address - Fax:856-227-1897
Practice Address - Street 1:901 ROUTE 168 STE 208
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-3203
Practice Address - Country:US
Practice Address - Phone:856-227-1898
Practice Address - Fax:856-227-1897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0087165Medicaid