Basic Information
| Provider Information | |||||||||
| NPI: | 1366855090 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | PATRICIA | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 938 BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | WESTFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070902604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9086006001 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 110 REHILL AVE | ||||||||
| Address2: | |||||||||
| City: | SOMERVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088762519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9086852900 | ||||||||
| FaxNumber: | 9087040083 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2014 | ||||||||
| LastUpdateDate: | 08/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | DO034625 | DC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 25MB10776500 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.