Healthcare Provider Details

I. General information

NPI: 1366760282
Provider Name (Legal Business Name): JOVANA YANIQUE MARTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 S MANNING BLVD STE 301
ALBANY NY
12208
US

IV. Provider business mailing address

PO BOX 14890
ALBANY NY
12212-4890
US

V. Phone/Fax

Practice location:
  • Phone: 518-458-1390
  • Fax: 518-459-3271
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number292628
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: