Provider Demographics
NPI:1538357744
Name:MARTIN, DONALD (PT)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:MARTIN
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 PALISADE AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3445
Mailing Address - Country:US
Mailing Address - Phone:201-399-0100
Mailing Address - Fax:201-399-0101
Practice Address - Street 1:870 PALISADE AVE STE 203
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3445
Practice Address - Country:US
Practice Address - Phone:201-399-0100
Practice Address - Fax:201-399-0101
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01153600225100000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist