Healthcare Provider Details

I. General information

NPI: 1215077227
Provider Name (Legal Business Name): MARIYA I MARTYNENKO MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 W PASSAIC ST STE 1
ROCHELLE PARK NJ
07662-3019
US

IV. Provider business mailing address

452 RIVER RD APT L
NUTLEY NJ
07110-3639
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-5161
  • Fax: 201-488-5162
Mailing address:
  • Phone: 973-661-5234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00315800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: