Healthcare Provider Details

I. General information

NPI: 1265850051
Provider Name (Legal Business Name): NICHOL STEPHEN MARTINEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NORTHERN BLVD STE 111
GREAT NECK NY
11021-5200
US

IV. Provider business mailing address

600 NORTHERN BLVD STE 111
GREAT NECK NY
11021-5200
US

V. Phone/Fax

Practice location:
  • Phone: 516-387-3990
  • Fax: 516-387-3930
Mailing address:
  • Phone: 516-387-3990
  • Fax: 516-387-3930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number281546
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: