MEDICARE: YANISLEIDY MARTINEZ

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1982092631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YANISLEIDY MARTINEZ

Provider Business Mailing Address
First Line	:	615 W 186TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-2633
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 W 186TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-2633
Country	:	US
Telephone Number	:	646-323-3957
Fax Number	:

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

Provider Enumeration Date	:	01/05/2015
Last Update Date	:	01/05/2015

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Directions to “ YANISLEIDY MARTINEZ ” Practice Location

Language	Start Address	Practice Location

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