Provider Demographics
NPI:1538309265
Name:MARTELLA, SALVATORE (CPO)
Entity type:Individual
Prefix:
First Name:SALVATORE
Middle Name:
Last Name:MARTELLA
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 MINEOLA AVE
Mailing Address - Street 2:PROGRESSIVE ORTHOTICS & PROSTHETICS
Mailing Address - City:CARLE PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11514
Mailing Address - Country:US
Mailing Address - Phone:516-338-8585
Mailing Address - Fax:516-338-7575
Practice Address - Street 1:516 MINEOLA AVE
Practice Address - Street 2:PROGRESSIVE ORTHOTICS & PROSTHETICS
Practice Address - City:CARLE PLACE
Practice Address - State:NY
Practice Address - Zip Code:11514
Practice Address - Country:US
Practice Address - Phone:516-338-8585
Practice Address - Fax:516-338-7575
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCPO 01602OtherCPO#