Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 154215 | NY |
NPI | 1003813775 |
---|---|
Provider Name | Dr. Amelia Martinko |
First Address | Mount Kisco, NY 10549-3446 |
Second Address | Poughkeepsie, NY 12601-3906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 18/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00794945 | (05) | NY |
C59142 | (02) | NY |