Healthcare Provider Details

I. General information

NPI: 1922882182
Provider Name (Legal Business Name): MOLLY MARTEL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E 41ST ST FL 21
NEW YORK NY
10017-6739
US

IV. Provider business mailing address

318 E 6TH ST APT 1
NEW YORK NY
10003-8743
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-7951
  • Fax:
Mailing address:
  • Phone: 714-722-4250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number352663
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: