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General NPI Number Information
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NPI Number | 1609149335
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Entity Type | Organization
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Legal Business Name | CHERYL D. MARTIN
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Dates
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Enumeration Date | 02/10/2012
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Last Update Date | 02/10/2012
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Provider Practice Location Address
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Address Line | 93 BARRETTS AVE
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City | HOLTSVILLE
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State | NY
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Zip | 11742-2114
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Country | US
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Telephone | 631-475-8819
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Fax |
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Provider Business Mailing Address
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Address Line | 93 BARRETTS AVE
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City | HOLTSVILLE
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State | NY
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Zip | 11742-2114
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Country | US
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Telephone | 631-475-8819
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Fax |
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Authorized Official
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Title or Position | RN
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Name | MRS. CHERYL D MARTIN
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Credential | REGISTERED NURSE
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Telephone | 631-475-8819
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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 | 420290-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 420290-1
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License Number State | NY
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