Provider Demographics
NPI:1336219286
Name:MARTINO, STEVE (PHD)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:MARTINO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 YORK ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06504-8900
Mailing Address - Country:US
Mailing Address - Phone:203-932-5711
Mailing Address - Fax:203-937-3472
Practice Address - Street 1:950 CAMPBELL AVE # 151-D
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-2770
Practice Address - Country:US
Practice Address - Phone:203-932-5711
Practice Address - Fax:203-937-3742
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001711261QM0850X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT680001396Medicare ID - Type Unspecified