Healthcare Provider Details

I. General information

NPI: 1851474597
Provider Name (Legal Business Name): CARMEN M MARTINEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 55TH ST STATION 20
BROOKLYN NY
11220-2559
US

IV. Provider business mailing address

150 55TH ST STATION 20
BROOKLYN NY
11220-2559
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-8758
  • Fax: 718-210-1059
Mailing address:
  • Phone: 718-630-8758
  • Fax: 718-210-1059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number148325
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: