MEDICARE: DR. ROSE ELISABETH MARTINEZ R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	5415941	NY
2	163WH0200X	Home Health Registered Nurse	5415941	NY

General Provider Information

NPI Number	:	1194004713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSE ELISABETH MARTINEZ R.N.

Provider Business Mailing Address
First Line	:	77 DECKER AVE
Second Line	:	SIDE ENTRANCE
City	:	STATEN ISLAND
State	:	NY
Zip	:	10302-2114
Country	:	US
Telephone Number	:	164-630-0197
Fax Number	:	164-630-0197

Provider Business Practice Location Address
First Line	:	77 DECKER AVE
Second Line	:	SIDE ENTRANCE
City	:	STATEN ISLAND
State	:	NY
Zip	:	10302-2114
Country	:	US
Telephone Number	:	164-630-0197
Fax Number	:	164-630-0197

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2011
Last Update Date	:	08/13/2011

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