Healthcare Provider Details

I. General information

NPI: 1740374750
Provider Name (Legal Business Name): REBECCA MARTINEZ ANESTHESIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 HIGH ST
NEWTON NJ
07860-1004
US

IV. Provider business mailing address

605 BROAD AVE SUITE 106
RIDGEFIELD NJ
07657-1697
US

V. Phone/Fax

Practice location:
  • Phone: 973-383-2121
  • Fax:
Mailing address:
  • Phone: 201-945-2481
  • Fax: 201-943-8105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MB06496200
License Number StateNJ

VIII. Authorized Official

Name: REBECCA MARTINEZ
Title or Position: OWNER
Credential: D.O.
Phone: 201-945-2481