Healthcare Provider Details

I. General information

NPI: 1588096424
Provider Name (Legal Business Name): EDWARD ANTHONY MARTINEZ FNP-BC, NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 1ST AVE ANESTHESIOLOGY DEPARTMENT 11E2 11TH FLOOR
NEW YORK NY
10016-9196
US

IV. Provider business mailing address

462 1ST AVE 11E2 ANESTHESIOLOGY DEPARTMENT
NEW YORK NY
10016-9196
US

V. Phone/Fax

Practice location:
  • Phone: 212-562-6577
  • Fax: 212-263-8643
Mailing address:
  • Phone: 212-562-6511
  • Fax: 212-263-8643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number338072
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: