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General NPI Number Information
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NPI Number | 1558399030
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Entity Type | Individual
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Provider Name | MICHAEL JOSEPH MARTINO MD
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Gender | Male
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 04/27/2018
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Provider Practice Location Address
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Address Line | 1031 MCBRIDE AVE STE D212
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City | WOODLAND PARK
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State | NJ
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Zip | 07424-2569
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Country | US
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Telephone | 973-837-0230
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Fax | 973-837-0234
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Provider Business Mailing Address
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Address Line | 1130 MCBRIDE AVE FL 3
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City | WOODLAND PARK
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State | NJ
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Zip | 07424-3806
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Country | US
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Telephone | 973-785-2277
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Fax | 973-785-2355
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MA04761000
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License Number State | NJ
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