1316977051 NPI number — STEFANI S. MARTIN, OD PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316977051 NPI number — STEFANI S. MARTIN, OD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEFANI S. MARTIN, OD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1316977051
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1155 E ATLANTIC AVE
Provider Second Line Business Mailing Address:
STE 104
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33483-6972
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-265-2020
Provider Business Mailing Address Fax Number:
561-258-0141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1155 E ATLANTIC AVE
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
DELRAY BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33483-6972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-265-2020
Provider Business Practice Location Address Fax Number:
561-258-0141
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
STEFANI
Authorized Official Middle Name:
SAYERS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-265-2020

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPC 4037 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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