Provider Demographics
NPI:1821422643
Name:MARTELLO, LISA
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:
Last Name:MARTELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3711 35TH AVE
Mailing Address - Street 2:SUITES 3C & 3G
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11101-1524
Mailing Address - Country:US
Mailing Address - Phone:718-706-7500
Mailing Address - Fax:
Practice Address - Street 1:3711 35TH AVE
Practice Address - Street 2:SUITES 3C & 3G
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11101-1524
Practice Address - Country:US
Practice Address - Phone:718-706-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist