Healthcare Provider Details

I. General information

NPI: 1679405609
Provider Name (Legal Business Name): OMAR E MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

166 E 118TH ST APT 9
NEW YORK NY
10035-4005
US

V. Phone/Fax

Practice location:
  • Phone: 646-595-6239
  • Fax:
Mailing address:
  • Phone: 646-595-6239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number030714
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: