Provider Demographics
NPI:1851423107
Name:MEYER, MARTHA ELLEN I (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:ELLEN
Last Name:MEYER
Suffix:I
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:MEYER
Other - Middle Name:MARTHA
Other - Last Name:PRESSER
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:66 CRISFIELD ST
Mailing Address - Street 2:APT3W
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-1243
Mailing Address - Country:US
Mailing Address - Phone:914-274-8768
Mailing Address - Fax:914-274-8768
Practice Address - Street 1:66 CRISFIELD ST
Practice Address - Street 2:APT3W
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-1243
Practice Address - Country:US
Practice Address - Phone:914-274-8768
Practice Address - Fax:914-274-8768
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165682163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0521Medicaid