Healthcare Provider Details

I. General information

NPI: 1265504666
Provider Name (Legal Business Name): WENDY MARTINEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 EVESHAM ROAD BLD 800 STE 122
VOORHEES NJ
08043
US

IV. Provider business mailing address

2301 EVESHAM RD BLDG 800, STE 122
VOORHEES NJ
08043-0598
US

V. Phone/Fax

Practice location:
  • Phone: 856-770-9300
  • Fax: 856-770-9518
Mailing address:
  • Phone: 856-770-9300
  • Fax: 856-770-8238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA04947300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: