Provider Demographics
NPI:1356511174
Name:PASSINO, MARTHA KATHLEEN (PNP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:KATHLEEN
Last Name:PASSINO
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:
Other - Last Name:CORRIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 CAREY RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-7880
Mailing Address - Country:US
Mailing Address - Phone:518-761-0300
Mailing Address - Fax:
Practice Address - Street 1:25 DEGRANDPRE WAY
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6449
Practice Address - Country:US
Practice Address - Phone:518-824-2563
Practice Address - Fax:833-448-3030
Is Sole Proprietor?:No
Enumeration Date:2008-03-07
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY381931363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02957404Medicaid