Healthcare Provider Details

I. General information

NPI: 1275400590
Provider Name (Legal Business Name): EMILY MARTINETION FNP-C
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 E 74TH ST APT 2A
NEW YORK NY
10021-3753
US

IV. Provider business mailing address

332 E 74TH ST APT 2A
NEW YORK NY
10021-3753
US

V. Phone/Fax

Practice location:
  • Phone: 631-662-1519
  • Fax:
Mailing address:
  • Phone: 631-662-1519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number360589
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: