Individual
CHIVAUGHN MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
506 MALCOLM X BLVD, NEW YORK, NY 10037-1802
(212) 939-1000
Mailing address
506 MALCOLM X BLVD, NEW YORK, NY 10037-1802
(718) 954-2884
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
22660674
NY
164W00000X
Licensed Practical Nurse
294837
NY
Other
Enumeration date
07/09/2010
Last updated
06/22/2015
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