Healthcare Provider Details

I. General information

NPI: 1811975519
Provider Name (Legal Business Name): GRACIANI MARTINEZ D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

387 W BLACKWELL ST
DOVER NJ
07801-2520
US

IV. Provider business mailing address

387 W BLACKWELL ST
DOVER NJ
07801-2520
US

V. Phone/Fax

Practice location:
  • Phone: 973-366-8000
  • Fax: 973-442-1300
Mailing address:
  • Phone: 973-366-8000
  • Fax: 973-442-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number25MD00276200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: