Healthcare Provider Details

I. General information

NPI: 1386304954
Provider Name (Legal Business Name): MARTHA LINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2021
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CROSS RIVER RD
KATONAH NY
10536-3549
US

IV. Provider business mailing address

2200 E TREMONT AVE APT 7H
BRONX NY
10462-6310
US

V. Phone/Fax

Practice location:
  • Phone: 914-763-8151
  • Fax:
Mailing address:
  • Phone: 347-946-5699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number403916
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1113638
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11186
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1113638
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number755489
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number199669
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: