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General NPI Number Information
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NPI Number | 1205196573
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Entity Type | Individual
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Provider Name | TIFFANY ANNMARIE MARTINEZ D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/21/2012
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Last Update Date | 07/18/2013
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Provider Practice Location Address
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Address Line | 901 W MAIN ST FL 2 SUITE 240
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City | FREEHOLD
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State | NJ
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Zip | 07728-2537
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Country | US
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Telephone | 732-308-2255
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Fax | 732-394-6432
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Provider Business Mailing Address
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Address Line | 20 CIVIC CENTER DR APT 4
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-3567
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Country | US
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Telephone | 732-841-0851
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Fax |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 25MB09325500
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License Number State | NJ
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