Individual
PHILEASE J MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2001 W MAIN ST, STAMFORD, CT 06902-4501
(203) 658-8291
(203) 658-8294
Mailing address
21715 JAMAICA AVE APT 2B, QUEENS VILLAGE, NY 11428-2122
(773) 910-2518
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
021588-1
NY
Other
Enumeration date
11/14/2017
Last updated
11/14/2017
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