Provider Demographics
NPI:1710370036
Name:MARTIN, ANTOINETTE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:ANTOINETTE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
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 336
Mailing Address - Street 2:
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444
Mailing Address - Country:US
Mailing Address - Phone:973-686-2237
Mailing Address - Fax:973-686-2258
Practice Address - Street 1:7 INDUSTRIAL RD
Practice Address - Street 2:
Practice Address - City:PEQUANNOCK
Practice Address - State:NJ
Practice Address - Zip Code:07440
Practice Address - Country:US
Practice Address - Phone:973-686-2237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR07486000163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse