Healthcare Provider Details

I. General information

NPI: 1083763718
Provider Name (Legal Business Name): MARCUS E MARTINEZ, MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 PARSONS AVE
HOOSICK FALLS NY
12090-1336
US

IV. Provider business mailing address

PO BOX 29 23 PARSONS AVENUE
HOOSICK FALLS NY
12090-0029
US

V. Phone/Fax

Practice location:
  • Phone: 518-686-5300
  • Fax:
Mailing address:
  • Phone: 518-686-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARCUS MARTINEZ
Title or Position: OWNDER
Credential: MD
Phone: 518-686-5300