Provider Demographics
NPI:1629479753
Name:MURPHY, MARTINA S (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:MARTINA
Middle Name:S
Last Name:MURPHY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:MARTINA
Other - Middle Name:
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:680 BROADWAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-1524
Mailing Address - Country:US
Mailing Address - Phone:973-925-2040
Mailing Address - Fax:
Practice Address - Street 1:680 BROADWAY
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1524
Practice Address - Country:US
Practice Address - Phone:973-925-2040
Practice Address - Fax:973-925-2044
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307152363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1629479753OtherNPI
NJAG1014060OtherAANP CERTIFICATION AS ADULT-GERONTOLOGY PRIMARY CARE NURSE PRACTITIONER
NYF307152OtherNURSE PRACTITIONER IN ADULT HEALTH
NJ1629479753OtherNPI
NY435053OtherREGISTERED NURSE
NJMM3465451OtherDEA
NJ0005358162-5OtherNSO LIABILITY INSURANCE
NJP00615200OtherCDS
NJ26NR09119200OtherREGISTERED NURSE