Provider Demographics
NPI:1194718205
Name:MARTINETTI, JOHN ALAN (AUD CCC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALAN
Last Name:MARTINETTI
Suffix:
Gender:M
Credentials:AUD CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5225 NESCONSET HWY
Mailing Address - Street 2:SUITE 10
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-2053
Mailing Address - Country:US
Mailing Address - Phone:631-331-1888
Mailing Address - Fax:631-331-4724
Practice Address - Street 1:5225 NESCONSET HWY
Practice Address - Street 2:SUITE 10
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2053
Practice Address - Country:US
Practice Address - Phone:631-331-1888
Practice Address - Fax:631-331-4724
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000898231H00000X
NY002232235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY014538OtherAETNA/US HEALTHCARE
NY0C4525OtherHEALTHNET
NM125886OtherUNITED HEALTHCARE
NY2814OtherVYTRA SPEECH
NY002232OtherHIP SPEECH ID#
NYM04241OtherEMPIRE BC/BS
NY0096400OtherAETNA/US HEALTHCARE GROUP
NY4210876OtherAETNA SPEECH ID#
NY865009OtherHIP MEDICAID
NYCS145OtherOXFORD
NY114520OtherVYTRA AUDIO
NY8457760OtherAETNA AUDIO
NY000898OtherHIP AUDIO ID#
NM125886OtherUNITED HEALTHCARE
NYCS145OtherOXFORD