Provider Demographics
NPI:1992859466
Name:MARTINEZ, MADELINE (RPA-C, LAC)
Entity Type:Individual
Prefix:MS
First Name:MADELINE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RPA-C, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2913
Mailing Address - Country:US
Mailing Address - Phone:516-439-5500
Mailing Address - Fax:
Practice Address - Street 1:999 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-2913
Practice Address - Country:US
Practice Address - Phone:516-439-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003304171100000X
NY005158363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No171100000XOther Service ProvidersAcupuncturist