Healthcare Provider Details

I. General information

NPI: 1104734920
Provider Name (Legal Business Name): KELLY BETH MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 W LANDIS AVE
VINELAND NJ
08360-8132
US

IV. Provider business mailing address

1976 N EAST AVE UNIT 272
VINELAND NJ
08360-2172
US

V. Phone/Fax

Practice location:
  • Phone: 856-772-5809
  • Fax: 856-772-5852
Mailing address:
  • Phone: 856-503-6548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: