Provider Demographics
NPI:1184307035
Name:MARTIN, ELIJAH DAVION (CNA)
Entity type:Individual
Prefix:
First Name:ELIJAH
Middle Name:DAVION
Last Name:MARTIN
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 DAVIS AVE # 1R
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-2904
Mailing Address - Country:US
Mailing Address - Phone:732-765-2115
Mailing Address - Fax:
Practice Address - Street 1:1117 E 125TH ST # THC
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-4127
Practice Address - Country:US
Practice Address - Phone:347-387-6749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2023-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty