Provider Demographics
NPI:1689959975
Name:DEMARTINO, MICHELE M (ATC)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:M
Last Name:DEMARTINO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:235 MILLBURN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1738
Mailing Address - Country:US
Mailing Address - Phone:973-258-1177
Mailing Address - Fax:973-258-8181
Practice Address - Street 1:235 MILLBURN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1738
Practice Address - Country:US
Practice Address - Phone:973-258-1177
Practice Address - Fax:973-258-8181
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer