Provider Demographics
NPI:1124509930
Name:MARTUCCI, DANIELLE ROSE
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ROSE
Last Name:MARTUCCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 BROOK ST
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-1726
Mailing Address - Country:US
Mailing Address - Phone:845-323-2022
Mailing Address - Fax:
Practice Address - Street 1:14 STURBRIDGE CT
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-1032
Practice Address - Country:US
Practice Address - Phone:845-623-3658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program