Provider Demographics
NPI:1952649048
Name:MARTIN, ELIZABETH MICHELLE (LAC, LMT)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MICHELLE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:MICHELLE
Other - Last Name:FOLK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC, LMT
Mailing Address - Street 1:1239 N COUNTRY RD
Mailing Address - Street 2:STE 3
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-1920
Mailing Address - Country:US
Mailing Address - Phone:631-601-6491
Mailing Address - Fax:
Practice Address - Street 1:1239 N COUNTRY RD
Practice Address - Street 2:SUITE 1D
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-1934
Practice Address - Country:US
Practice Address - Phone:631-601-6491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00514901171100000X
NY27027004225700000X
NY25005149171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist