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NPI Code Detail

MEDICARE: ANGELIQUE MARTIN R.D, C.D.N

MEDICARE: ANGELIQUE MARTIN R.D, C.D.N
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
1132700000XDietary Manager189769NY
2133V00000XRegistered Dietitian005623-1NY
3133VN1006XMetabolic Nutrition Registered Dietitian005623-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12579429OTHERNYUNITED HEALTHCARE
2P3105474OTHERNYOXFORD
3155835POTHERNYHIP
4182870OTHERNYELDERPLAN
58099800OTHERNYGHI
69607811OTHERNYCIGNA
7P3105806OTHERNYOXFORD

General Provider Information

NPI Number : 1922009034
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELIQUE MARTIN R.D, C.D.N
Provider Business Mailing Address
First Line : 2035 RALPH AVE # A8
Second Line :
City : BROOKLYN
State : NY
Zip : 11234-5300
Country : US
Telephone Number : 646-752-9842
Fax Number :
Provider Business Practice Location Address
First Line : 2035 RALPH AVE STE A8
Second Line :
City : BROOKLYN
State : NY
Zip : 11234-5300
Country : US
Telephone Number : 646-752-9842
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2005
Last Update Date : 01/30/2025

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