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General NPI Number Information
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NPI Number | 1144432923
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Entity Type | Individual
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Provider Name | PHILIP ROBERT MARTINEZ APRN, MSN
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Gender | Male
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 800 HOWARD AVE YALE PHYSICIANS BLDG
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City | NEW HAVEN
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State | CT
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Zip | 06519-1369
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Country | US
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Telephone | 203-785-2140
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Fax | 203-785-6414
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Provider Business Mailing Address
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Address Line | PO BOX 9805 300 GEORGE ST 6TH FLR
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City | NEW HAVEN
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State | CT
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Zip | 06536-0805
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Country | US
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Telephone | 203-785-7998
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Fax | 203-785-6414
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 003547
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License Number State | CT
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