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General NPI Number Information
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NPI Number | 1912210238
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Entity Type | Individual
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Provider Name | ERIN ELISABETH MARTHEDAL PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/15/2010
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 1 ROBERT WOOD JOHNSON PL MEB 104
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-1928
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Country | US
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Telephone | 732-235-8717
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Fax | 732-235-7379
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Provider Business Mailing Address
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Address Line | 47 MERCER ST APT 3A
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City | JERSEY CITY
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State | NJ
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Zip | 07302-5530
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Country | US
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Telephone | 559-940-2606
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00238300
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License Number State | NJ
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