Basic Information
| Provider Information | |||||||||
| NPI: | 1356694392 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTONE TARANTINO | ||||||||
| FirstName: | HEATHER | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 242 MASON AVE | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103053408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189870128 | ||||||||
| FaxNumber: | 7189870223 | ||||||||
| Practice Location | |||||||||
| Address1: | 456 CROWN AVE | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103122743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3478370687 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2012 | ||||||||
| LastUpdateDate: | 09/16/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 337632 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.