Provider Demographics
NPI:1780023366
Name:MARTINTA, ANDREZA (RN)
Entity Type:Individual
Prefix:
First Name:ANDREZA
Middle Name:
Last Name:MARTINTA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 CHARLES ST
Mailing Address - Street 2:APT 1A
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-1905
Mailing Address - Country:US
Mailing Address - Phone:516-323-9418
Mailing Address - Fax:
Practice Address - Street 1:74 MILL DR
Practice Address - Street 2:
Practice Address - City:MASTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11951-1403
Practice Address - Country:US
Practice Address - Phone:516-323-9418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY670172-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse