Healthcare Provider Details

I. General information

NPI: 1417711052
Provider Name (Legal Business Name): HALEY MARTTILA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 08/05/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 MULE RD STE 1E
TOMS RIVER NJ
08755-5052
US

IV. Provider business mailing address

9 MULE RD STE 1E
TOMS RIVER NJ
08755-5052
US

V. Phone/Fax

Practice location:
  • Phone: 732-281-1101
  • Fax:
Mailing address:
  • Phone: 732-281-1101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00857000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: