MEDICARE: ELIJAH DAVION MARTIN CNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1184307035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIJAH DAVION MARTIN CNA

Provider Business Mailing Address
First Line	:	544 DAVIS AVE # 1R
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10310-2904
Country	:	US
Telephone Number	:	732-765-2115
Fax Number	:

Provider Business Practice Location Address
First Line	:	1117 E 125TH ST # THC
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44112-4127
Country	:	US
Telephone Number	:	347-387-6749
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2023
Last Update Date	:	08/12/2023

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Directions to “ ELIJAH DAVION MARTIN CNA” Practice Location

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