Basic Information
Provider Information | |||||||||
NPI: | 1801233150 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MARTINEZ | ||||||||
FirstName: | DEBORAH | ||||||||
MiddleName: | LEE | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LPN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | FRIEDRICH | ||||||||
OtherFirstName: | DEBORAH | ||||||||
OtherMiddleName: | LEE | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 700 VETERANS HWY | ||||||||
Address2: | 200 | ||||||||
City: | HAUPPAUGE | ||||||||
State: | NY | ||||||||
PostalCode: | 117882952 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6318633700 | ||||||||
FaxNumber: | 6318633705 | ||||||||
Practice Location | |||||||||
Address1: | 700 VETERANS HWY | ||||||||
Address2: | 200 | ||||||||
City: | HAUPPAUGE | ||||||||
State: | NY | ||||||||
PostalCode: | 117882952 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6318633700 | ||||||||
FaxNumber: | 6318633705 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/28/2013 | ||||||||
LastUpdateDate: | 05/28/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 280593 | NY | Y |   | Agencies | Home Health |   |
No ID Information.