Basic Information
| Provider Information | |||||||||
| NPI: | 1467571067 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | NATHALIE | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 NICOLLS RD # T16-080 | ||||||||
| Address2: | |||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117948167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314441066 | ||||||||
| FaxNumber: | 6314441054 | ||||||||
| Practice Location | |||||||||
| Address1: | 676 COUNTY ROAD 39A | ||||||||
| Address2: | |||||||||
| City: | SOUTHAMPTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119685241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6317028327 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 02/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 469900 | NY | N | Nursing Service Providers | Registered Nurse | 363L00000X | F303624 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.