Healthcare Provider Details

I. General information

NPI: 1528616083
Provider Name (Legal Business Name): JENNY MARTINSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 MIDDLE COUNTRY RD FL 2
CORAM NY
11727-4432
US

IV. Provider business mailing address

576 BROADHOLLOW RD
MELVILLE NY
11747-5002
US

V. Phone/Fax

Practice location:
  • Phone: 631-716-2700
  • Fax: 631-716-2782
Mailing address:
  • Phone: 631-359-5859
  • Fax: 631-396-0864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: