Healthcare Provider Details

I. General information

NPI: 1982844130
Provider Name (Legal Business Name): STACY M MARTINUCCI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2009
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 ROCKWOOD PLACE SUITE 305
ENGLEWOOD NJ
07631
US

IV. Provider business mailing address

25 ROCKWOOD PLACE SUITE 305
ENGLEWOOD NJ
07631
US

V. Phone/Fax

Practice location:
  • Phone: 201-894-0003
  • Fax: 201-894-0006
Mailing address:
  • Phone: 201-894-0003
  • Fax: 201-894-0006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA08529800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number242309-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: