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General NPI Number Information
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NPI Number | 1467850966
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Entity Type | Individual
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Provider Name | GISELLE LORENA MARTIN D.C
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Gender | Female
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Dates
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Enumeration Date | 12/15/2014
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Last Update Date | 08/20/2020
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Provider Practice Location Address
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Address Line | 3256 STEINWAY ST SUITE B
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City | ASTORIA
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State | NY
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Zip | 11103-4006
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Country | US
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Telephone | 718-619-8913
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Fax |
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Provider Business Mailing Address
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Address Line | 3256 STEINWAY ST STE B
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City | ASTORIA
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State | NY
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Zip | 11103-4006
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Country | US
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Telephone | 718-278-0734
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X012608-1
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License Number State | NY
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