Provider Demographics
NPI:1356601124
Name:MARTIN, CATHERINE SUSANNE (RPA-C)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:SUSANNE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 E 76TH ST
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2810
Mailing Address - Country:US
Mailing Address - Phone:212-794-2800
Mailing Address - Fax:212-794-2899
Practice Address - Street 1:155 E 76TH ST
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2810
Practice Address - Country:US
Practice Address - Phone:212-794-2800
Practice Address - Fax:212-794-2899
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003829363A00000X
NY015479363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant