MEDICARE: MR. MARTINY ST. JUSTE CEO

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	2279H0200X	Home Health Registered Respiratory Therapist	004163	NY

General Provider Information

NPI Number	:	1770905309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARTINY ST. JUSTE CEO

Provider Business Mailing Address
First Line	:	139 N 17TH ST
Second Line	:
City	:	WHEATLEY HEIGHTS
State	:	NY
Zip	:	11798-1816
Country	:	US
Telephone Number	:	631-880-0961
Fax Number	:

Provider Business Practice Location Address
First Line	:	1564 NEW YORK AVE
Second Line	:
City	:	HUNTINGTON STATION
State	:	NY
Zip	:	11746-1727
Country	:	US
Telephone Number	:	631-421-6148
Fax Number	:

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

Provider Enumeration Date	:	01/16/2014
Last Update Date	:	01/16/2014

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