Provider Demographics
NPI:1679714109
Name:MURPHY, MARTINE GRECO (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MARTINE
Middle Name:GRECO
Last Name:MURPHY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:MARTINE
Other - Middle Name:M
Other - Last Name:GRECO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 2005
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-4505
Mailing Address - Country:US
Mailing Address - Phone:315-362-5129
Mailing Address - Fax:315-362-5179
Practice Address - Street 1:736 IRVING AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1687
Practice Address - Country:US
Practice Address - Phone:315-470-7828
Practice Address - Fax:315-470-5811
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY526178367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400003174Medicare PIN