Provider Demographics
NPI:1891392155
Name:O'REILLY, MARTINA MARY (RN)
Entity Type:Individual
Prefix:
First Name:MARTINA
Middle Name:MARY
Last Name:O'REILLY
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 1:15 HILLSIDE AVE # 714
Mailing Address - Street 2:
Mailing Address - City:TUXEDO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:10987-4423
Mailing Address - Country:US
Mailing Address - Phone:845-774-9446
Mailing Address - Fax:
Practice Address - Street 1:706 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-2038
Practice Address - Country:US
Practice Address - Phone:845-362-3900
Practice Address - Fax:845-362-5083
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY542070-01163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)