Healthcare Provider Details

I. General information

NPI: 1063375970
Provider Name (Legal Business Name): SAMUEL X MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

574 NEW JERSEY AVE
LYNDHURST NJ
07071-2208
US

IV. Provider business mailing address

574 NEW JERSEY AVE
LYNDHURST NJ
07071-2208
US

V. Phone/Fax

Practice location:
  • Phone: 201-519-7432
  • Fax:
Mailing address:
  • Phone: 201-519-7432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License NumberM06916888707972
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberM06916888707972
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: