Healthcare Provider Details

I. General information

NPI: 1831027366
Provider Name (Legal Business Name): MARYAN-ROSE MARTINEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 WADSWORTH AVE APT 5G
NEW YORK NY
10033-2537
US

IV. Provider business mailing address

258 WADSWORTH AVE APT 5G
NEW YORK NY
10033-2537
US

V. Phone/Fax

Practice location:
  • Phone: 347-840-1000
  • Fax:
Mailing address:
  • Phone: 347-840-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number823039
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: