Provider Demographics
NPI:1679707863
Name:MARTUSHEV, TANYA (LMT)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:
Last Name:MARTUSHEV
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1262
Mailing Address - Street 2:COOPER STATION
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10276-1262
Mailing Address - Country:US
Mailing Address - Phone:917-593-5982
Mailing Address - Fax:
Practice Address - Street 1:251 5TH AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6515
Practice Address - Country:US
Practice Address - Phone:917-593-5982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020997225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist