Provider Demographics
NPI:1780150441
Name:MARTINI, MAGDALENA (PA-C, PHD)
Entity type:Individual
Prefix:MS
First Name:MAGDALENA
Middle Name:
Last Name:MARTINI
Suffix:
Gender:
Credentials:PA-C, PHD
Other - Prefix:MS
Other - First Name:MAGDALENA
Other - Middle Name:
Other - Last Name:PODGORNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:4 GLENRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2402
Mailing Address - Country:US
Mailing Address - Phone:347-695-6846
Mailing Address - Fax:
Practice Address - Street 1:100 NICOLLS RD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-2402
Practice Address - Country:US
Practice Address - Phone:631-444-1066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022863363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant