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General NPI Number Information
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NPI Number | 1306210497
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Entity Type | Individual
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Provider Name | MARTHA EUGENE REGISTERED NURSE
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Gender | Female
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Dates
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Enumeration Date | 11/30/2015
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Last Update Date | 11/05/2021
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Provider Practice Location Address
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Address Line | 680 CARROLL ST # 1
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City | BROOKLYN
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State | NY
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Zip | 11215-2010
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Country | US
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Telephone | 718-484-8218
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Fax |
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Provider Business Mailing Address
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Address Line | 201 LINDEN BLVD
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City | BROOKLYN
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State | NY
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Zip | 11226-3498
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Country | US
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Telephone | 347-787-5058
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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 | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 8733919
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 738393
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License Number State | NY
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