Provider Demographics
NPI:1952501462
Name:MARTIN, AMY LEA (PNP)
Entity Type:Individual
Prefix:MISS
First Name:AMY
Middle Name:LEA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CHRISTOPHER COLUMBUS DR
Mailing Address - Street 2:APT 2812
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-7005
Mailing Address - Country:US
Mailing Address - Phone:646-761-5618
Mailing Address - Fax:
Practice Address - Street 1:WINTHROP-UNIVERSITY HOSPITAL
Practice Address - Street 2:259 FIRST STREET
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501
Practice Address - Country:US
Practice Address - Phone:516-663-0333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381863-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics