MEDICARE: DONALD MARTINELLI PHYSICIAN, PC

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	207R00000X	Internal Medicine Physician	187901	NY

General Provider Information

NPI Number	:	1437556925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONALD MARTINELLI PHYSICIAN, PC

Provider Business Mailing Address
First Line	:	1270 85TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-3310
Country	:	US
Telephone Number	:	718-833-6161
Fax Number	:	718-491-3483

Provider Business Practice Location Address
First Line	:	8306 13TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-3018
Country	:	US
Telephone Number	:	718-833-6161
Fax Number	:	718-491-3483

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DONALD MARTINELLI
Credential	:	MD
Telephone Number	:	718-833-6161

Provider Enumeration Date	:	11/26/2014
Last Update Date	:	11/26/2014

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