1861403867 NPI number — MS. LORETTA A MARTIN RPA

Table of content: MS. LORETTA A MARTIN RPA (NPI 1861403867)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861403867 NPI number — MS. LORETTA A MARTIN RPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
LORETTA
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RPA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861403867
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
575 HUDSON VALLEY AVE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
NEW WINDSOR
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12553
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-220-2270
Provider Business Mailing Address Fax Number:
845-220-2277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
575 HUDSON VALLEY AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
NEW WINDSOR
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-220-2270
Provider Business Practice Location Address Fax Number:
845-220-2277
Provider Enumeration Date:
08/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  0006161 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 173000000X , with the licence number: 000616-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 356305 . This is a "MVP INS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".