Healthcare Provider Details

I. General information

NPI: 1891474490
Provider Name (Legal Business Name): VANESSA ANELIS MARTE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 04/27/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 BAINBRIDGE AVE
BRONX NY
10467-2403
US

IV. Provider business mailing address

1042 E 223RD ST APT 1
BRONX NY
10466-4814
US

V. Phone/Fax

Practice location:
  • Phone: 718-741-2000
  • Fax:
Mailing address:
  • Phone: 347-290-2846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number355888
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number738082
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: