Provider Demographics
NPI:1588067235
Name:MARTELLO, ERICA LYNN (PT, DPT)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LYNN
Last Name:MARTELLO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 FULTON ST
Mailing Address - Street 2:STE B
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3638
Mailing Address - Country:US
Mailing Address - Phone:516-420-1927
Mailing Address - Fax:516-420-1952
Practice Address - Street 1:27003 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2517
Practice Address - Country:US
Practice Address - Phone:718-831-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038119225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ4WFH1Medicare PIN
NY03248Medicare PIN