Ann Marie Martin, AUD CCCA MS BS

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

002090 Issued in NY

Practice address

5100 W Taft Rd
Suite 4L
Liverpool, NY 13088-3807

Phone

(315) 452-2124

NPI assigned

Aug 1, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ms. Annmarie Ilczyszyn Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor of Science, Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486425600000",
    "number": "1487660015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8403 WOODBOX RD",
            "city": "MANLIUS",
            "state": "NY",
            "postal_code": "131049416",
            "telephone_number": "315-751-3142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 W TAFT RD",
            "address_2": "SUITE 4L",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130883807",
            "telephone_number": "315-452-2124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "ANN MARIE",
        "name_prefix": "Dr.",
        "credential": "AUD CCCA MS BS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-01",
        "last_updated": "2017-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NY",
            "license": "002090",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00561353",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANNMARIE",
            "last_name": "ILCZYSZYN",
            "prefix": "MS.",
            "credential": "AU.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Heather Marcella Marino, LMSW
• David M Markham, PT
• Tania Urszula Marschall
• Christine Lee Marsh, M.A.,CCC
• Mia Martans, COUNSELOR
• Lyndsey Noel Martin, PNP
• Elena M Martinez
• Scott Charles Martini, D.D.S.
• Erin E Mason
• Sharlene R Mason, LPN

• Otolaryngology Physician in Liverpool, NY
• Providers in Liverpool, NY by specialty
• Otolaryngology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.