Provider Demographics
NPI:1205118866
Name:MARTINSEN, ANDREA JEANNE (MS, RD, CDN)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:JEANNE
Last Name:MARTINSEN
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 FORT WASHINGTON AVE
Mailing Address - Street 2:#2Y
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040
Mailing Address - Country:US
Mailing Address - Phone:617-365-3097
Mailing Address - Fax:
Practice Address - Street 1:720 FORT WASHINGTON AVE
Practice Address - Street 2:#2Y
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-3708
Practice Address - Country:US
Practice Address - Phone:617-365-3097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006782-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered