Provider Demographics
NPI:1194995985
Name:MARTIN, JOANNE RYAN (NP)
Entity type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:RYAN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 LIBERTY SQUARE MALL
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-2400
Mailing Address - Country:US
Mailing Address - Phone:845-429-6900
Mailing Address - Fax:845-429-7050
Practice Address - Street 1:27 LIBERTY SQUARE MALL
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980-2400
Practice Address - Country:US
Practice Address - Phone:845-429-6900
Practice Address - Fax:845-429-7050
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY381468363LP0200X
NY4009003363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics