Healthcare Provider Details

I. General information

NPI: 1093723710
Provider Name (Legal Business Name): MARTHA W TAYLOR CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 LINWOOD AVE
NORTH BELLMORE NY
11710-2409
US

IV. Provider business mailing address

108 LINWOOD AVE
NORTH BELLMORE NY
11710-2409
US

V. Phone/Fax

Practice location:
  • Phone: 516-221-8924
  • Fax: 516-783-8246
Mailing address:
  • Phone: 516-221-8924
  • Fax: 516-783-8246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number305202
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: