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General NPI Number Information
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NPI Number | 1417630302
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Entity Type | Individual
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Provider Name | MARTIN MARTINICKY
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Gender | Male
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Dates
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Enumeration Date | 08/08/2023
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Last Update Date | 08/08/2023
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Provider Practice Location Address
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Address Line | 61 JERICHO TPKE
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City | JERICHO
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State | NY
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Zip | 11753-1051
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Country | US
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Telephone | 516-544-8899
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Fax | 516-362-3939
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Provider Business Mailing Address
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Address Line | 9972 66TH RD APT 7D
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City | REGO PARK
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State | NY
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Zip | 11374-4443
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Country | US
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Telephone | 516-587-1113
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 432741
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License Number State | NY
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