MEDICARE: MS. IRIS MARGOTH MARTINEZ MSED

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	252Y00000X	Early Intervention Provider Agency	074729179	NY

General Provider Information

NPI Number	:	1295985844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IRIS MARGOTH MARTINEZ MSED

Provider Business Mailing Address
First Line	:	255 HUGUENOT ST
Second Line	:
City	:	NEW ROCHELLE
State	:	NY
Zip	:	10801-6387
Country	:	US
Telephone Number	:	347-297-1880
Fax Number	:	914-740-4846

Provider Business Practice Location Address
First Line	:	255 HUGUENOT ST APT 1110
Second Line	:
City	:	NEW ROCHELLE
State	:	NY
Zip	:	10801-6396
Country	:	US
Telephone Number	:	347-297-1880
Fax Number	:	914-740-4846

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

Provider Enumeration Date	:	09/19/2008
Last Update Date	:	09/19/2008

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