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General NPI Number Information
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NPI Number | 1013924554
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Entity Type | Individual
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Provider Name | MARTINA L BRADY ATC
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Gender | Female
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1983 MARCUS AVE STE 117
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1016
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Country | US
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Telephone | 516-297-0079
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Fax |
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Provider Business Mailing Address
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Address Line | 91 NORTH ST
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City | HUNTINGTON STATION
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State | NY
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Zip | 11746-1354
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Country | US
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Telephone | 516-426-9607
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 001371
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License Number State | NY
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