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General NPI Number Information
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NPI Number | 1114159423
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Entity Type | Individual
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Provider Name | DANIELLE MARTIN D.O.
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Gender | Female
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Dates
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Enumeration Date | 08/20/2009
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Last Update Date | 01/23/2019
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Provider Practice Location Address
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Address Line | 92 PONDEROSA LN
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City | MELVILLE
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State | NY
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Zip | 11747-2017
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Country | US
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Telephone | 516-302-3667
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Fax | 631-302-6658
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Provider Business Mailing Address
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Address Line | 74-03 COMMONWEALTH BLVD
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City | BELLEROSE
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State | NY
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Zip | 11426-1150
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Country | US
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Telephone | 718-264-4637
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Fax | 718-264-4886
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 254791
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License Number State | NY
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