Healthcare Provider Details

I. General information

NPI: 1699899666
Provider Name (Legal Business Name): ARMANDO IVAN MARTINEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 COUNTY AVENUE
SECAUCUS NJ
07094
US

IV. Provider business mailing address

510 TEAL PLAZA
SECAUCUS NJ
07094
US

V. Phone/Fax

Practice location:
  • Phone: 201-319-1611
  • Fax: 201-319-1233
Mailing address:
  • Phone: 201-617-7609
  • Fax: 201-319-1611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberMA35994
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: