Healthcare Provider Details

I. General information

NPI: 1992332191
Provider Name (Legal Business Name): FERNANDO MARTINEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 CO OP CITY BLVD
BRONX NY
10475-1603
US

IV. Provider business mailing address

PO BOX 22239
NEW YORK NY
10087-0001
US

V. Phone/Fax

Practice location:
  • Phone: 201-654-6397
  • Fax: 201-608-9241
Mailing address:
  • Phone: 201-654-6397
  • Fax: 201-608-9241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number344840
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: