| Doctor Name: | MRS. JACQUELINE E MARTIN |
| NPI Number: | 1114208089 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, RD, CDN |
| License Number: | 006357 |
| Business Practice Address: | 13 Avenue Louise Massapequa Park, NY - 117623207 |
| Business Phone Number: | 5162363984 |
| Business Fax Number: | |
| Mailing Address: | 13 Avenue Louise, MASSAPEQUA PARK |
| State: | NY |
| Postal Code: | 117623207 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/06/2011 |
| NPI Last Update Date: | 09/06/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133VN1004X |
| License Number: | 006357 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | Nutrition, Pediatric |
| Taxonomy Definition: | |