MEDICARE: DR. MARY ELLEN MARTIN DVM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174M00000X	Veterinarian	011831-1	NY

General Provider Information

NPI Number	:	1689967077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY ELLEN MARTIN DVM

Provider Business Mailing Address
First Line	:	7624 NEW UTRECTH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214
Country	:	US
Telephone Number	:	718-331-7775
Fax Number	:

Provider Business Practice Location Address
First Line	:	7624 NEW UTRECHT AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-1022
Country	:	US
Telephone Number	:	718-331-7775
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2011
Last Update Date	:	01/23/2014

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