1609394865 NPI number — CARMEN NEREIDA MARTIN LPN

Table of content: CARMEN NEREIDA MARTIN LPN (NPI 1609394865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609394865 NPI number — CARMEN NEREIDA MARTIN LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
CARMEN
Provider Middle Name:
NEREIDA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPN
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:
1609394865
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16-24 UNION STREET
Provider Second Line Business Mailing Address:
NURSING
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-421-6463
Provider Business Mailing Address Fax Number:
845-343-8396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16-24 UNION STREET
Provider Second Line Business Practice Location Address:
NURSING OFFICE
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-421-6463
Provider Business Practice Location Address Fax Number:
845-343-8396
Provider Enumeration Date:
09/07/2017

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: 164W00000X , with the licence number:  082444 , 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: 082441 . This is a "NYS DOE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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