MEDICARE: MIGUEL A MARTINEZ MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00030241501	OTHER	NY	UNIVERA
2	000506354005	OTHER	NY	COMMUNITY BLUE

General Provider Information

NPI Number	:	1558432864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIGUEL A MARTINEZ MSW

Provider Business Mailing Address
First Line	:	430 NIAGARA ST
Second Line	:	#2
City	:	BUFFALO
State	:	NY
Zip	:	14201-1886
Country	:	US
Telephone Number	:	716-856-9711
Fax Number	:	716-856-2608

Provider Business Practice Location Address
First Line	:	430 NIAGARA ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14201-1886
Country	:	US
Telephone Number	:	716-856-9711
Fax Number	:	716-856-2608

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	06/14/2013

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