Provider Demographics
NPI:1629437140
Name:MARTELLONI-BRENNAN, CLAUDIA LAURA
Entity Type:Individual
Prefix:MRS
First Name:CLAUDIA
Middle Name:LAURA
Last Name:MARTELLONI-BRENNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 WILAFRA PL
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2160
Mailing Address - Country:US
Mailing Address - Phone:631-662-3141
Mailing Address - Fax:
Practice Address - Street 1:23 WILAFRA PL
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2160
Practice Address - Country:US
Practice Address - Phone:631-662-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-11
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1694775174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist