Healthcare Provider Details

I. General information

NPI: 1679326037
Provider Name (Legal Business Name): ERICK FABIAN MARTIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CLINTON PL APT 513
NEW ROCHELLE NY
10801-6700
US

IV. Provider business mailing address

55 CLINTON PL APT 513
NEW ROCHELLE NY
10801-6700
US

V. Phone/Fax

Practice location:
  • Phone: 252-258-6678
  • Fax:
Mailing address:
  • Phone: 252-258-6678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: