Individual provider Active NPI

Leah Martin, PA-C

  • Physician Assistant
  • Lakewood, NJ
National Provider Identifier
1710490487
Registry record updated Nov 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
021636 Issued in NY
Practice address
120 Glen Ave Apt a
Lakewood, NJ 08701-3059
Phone
(845) 502-2464
NPI assigned
Nov 15, 2017
Last updated
Nov 24, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 021636 NY Primary

Addresses

Primary practice location

120 Glen Ave Apt a
Lakewood, NJ 08701-3059

Mailing address

120 Glen Ave Apt a
Lakewood, NJ 08701-3059

Other practice location 1

12 Patricia Ln
Spring Valley, NY 10977-1601
Phone (845) 548-9609

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210120003121 NJ Practitioner - Physician Assistant 3274897970 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1771 Madison Ave
Lakewood, NJ 08701-1242
Phone (732) 364-2144

1771 Madison Ave
Lakewood, NJ 08701-1251

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
021636NYMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Lakewood Resource and Referral Center, Inc. CurrentSince Jan 1, 2021 Accepting new patients
Lakewood Resource and Referral Center, Inc. CurrentSince Jan 1, 2021 Accepting new patients
Lakewood Resource and Referral Center Inc Past Accepting new patients

Locations

1771 Madison Ave
Lakewood, NJ 08701
Phone (732) 364-2144

1771 Madison Ave
#9
Lakewood, NJ 08701

Interoperability endpoints

  • Direct secure messaging: leah.martin@chemed.eclinicaldirectplus.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1510704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606176000000",
    "number": "1710490487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 GLEN AVE APT A",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087013059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 GLEN AVE APT A",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087013059",
            "telephone_number": "845-502-2464"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12 Patricia Ln",
            "address_purpose": "LOCATION",
            "city": "Spring Valley",
            "state": "NY",
            "postal_code": "109771601",
            "country_code": "US",
            "telephone_number": "845-548-9609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "LEAH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-15",
        "last_updated": "2020-11-24",
        "certification_date": "2020-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "021636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, NJ

Sources for this page

Verify at the official NPI Registry.