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General NPI Number Information
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NPI Number | 1902529811
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Entity Type | Individual
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Provider Name | JUAN TOMAS MARTINEZ
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Gender | Male
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Dates
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Enumeration Date | 09/26/2022
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Last Update Date | 09/26/2022
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Provider Practice Location Address
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Address Line | 1111 AMSTERDAM AVE
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City | NEW YORK
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State | NY
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Zip | 10025-1716
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Country | US
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Telephone | 646-479-4447
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Fax |
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Provider Business Mailing Address
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Address Line | 50 GLENBROOK RD APT 4D
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City | STAMFORD
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State | CT
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Zip | 06902-2949
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Country | US
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Telephone | 646-479-4447
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 350423
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License Number State | NY
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