Healthcare Provider Details

I. General information

NPI: 1164945309
Provider Name (Legal Business Name): RICARDO ALBERTO BELLO MARTINEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8268 164TH ST
JAMAICA NY
11432-1121
US

IV. Provider business mailing address

3048 ENTERPRISE DR
STATE COLLEGE PA
16801-2755
US

V. Phone/Fax

Practice location:
  • Phone: 718-883-4080
  • Fax:
Mailing address:
  • Phone: 877-235-7686
  • Fax: 814-235-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number2025-00316
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number320026
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License NumberMD478974
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: