Healthcare Provider Details

I. General information

NPI: 1154243954
Provider Name (Legal Business Name): KIYA MARTIN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 TRUMAN DR APT 305
EDISON NJ
08817-2450
US

IV. Provider business mailing address

115 TRUMAN DR APT 305
EDISON NJ
08817-2450
US

V. Phone/Fax

Practice location:
  • Phone: 732-572-6522
  • Fax:
Mailing address:
  • Phone: 732-572-6522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: