Healthcare Provider Details

I. General information

NPI: 1669317715
Provider Name (Legal Business Name): JEANNIE MARTINEZ-GONZALES RT(R)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 LAVENTHAL AVE
IRVINGTON NJ
07111-2842
US

IV. Provider business mailing address

26 LAVENTHAL AVE
IRVINGTON NJ
07111-2842
US

V. Phone/Fax

Practice location:
  • Phone: 646-358-6292
  • Fax:
Mailing address:
  • Phone: 646-358-6292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number638052
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: