Provider Demographics
NPI:1801892948
Name:MARTIN, JAMES ALLEN (RPAC,ARNP)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ALLEN
Last Name:MARTIN
Suffix:
Gender:M
Credentials:RPAC,ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 SARATOGA RD
Mailing Address - Street 2:APT. T-05
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-4108
Mailing Address - Country:US
Mailing Address - Phone:716-984-9309
Mailing Address - Fax:
Practice Address - Street 1:133 SARATOGA RD
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12302-4108
Practice Address - Country:US
Practice Address - Phone:716-984-9309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1330363AM0700X
FL9242972363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01271498Medicaid
NYJ40006752Medicare PIN
NY01271498Medicaid