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General NPI Number Information
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NPI Number | 1922009034
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Entity Type | Individual
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Provider Name | ANGELIQUE MARTIN R.D, C.D.N
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Gender | Female
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 2035 RALPH AVE STE A8
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City | BROOKLYN
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State | NY
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Zip | 11234-5300
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Country | US
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Telephone | 646-752-9842
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Fax |
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Provider Business Mailing Address
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Address Line | 2035 RALPH AVE # A8
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City | BROOKLYN
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State | NY
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Zip | 11234-5300
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Country | US
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Telephone | 646-752-9842
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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 | 132700000X
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Taxonomy Name | Dietary Manager
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License Number | 189769
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 005623-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number | 005623-1
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License Number State | NY
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