Individual
ANGELIQUE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D, C.D.N
Contact information
Practice address
2035 RALPH AVE STE A8, BROOKLYN, NY 11234-5300
(646) 752-9842
Mailing address
2035 RALPH AVE # A8, BROOKLYN, NY 11234-5300
(646) 752-9842
Taxonomy
Speciality
Code
Description
License number
State
132700000X
Dietary Manager
189769
NY
133V00000X
Registered Dietitian
005623-1
NY
133VN1006X
Metabolic Nutrition Registered Dietitian
Primary
005623-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
155835P
HIP
NY
01
—
182870
ELDERPLAN
NY
01
—
2579429
UNITED HEALTHCARE
NY
01
—
8099800
GHI
NY
01
—
9607811
CIGNA
NY
01
—
P3105474
OXFORD
NY
01
—
P3105806
OXFORD
NY
Enumeration date
08/10/2005
Last updated
01/30/2025
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