Healthcare Provider Details

I. General information

NPI: 1104908391
Provider Name (Legal Business Name): CORINNE D MARTIN CNM, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 LONG POND RD DEPT. OF OBSTETRICS AND GYNECOLOGY
ROCHESTER NY
14626-4122
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-368-4007
  • Fax: 585-368-4009
Mailing address:
  • Phone: 585-922-0553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberF360478
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberF001156
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: