MEDICARE: MS. BESAIRA ELVIRA MARTINEZ

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1558107243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BESAIRA ELVIRA MARTINEZ

Provider Business Mailing Address
First Line	:	735 PELHAM PKWY N
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-9507
Country	:	US
Telephone Number	:	347-208-4846
Fax Number	:

Provider Business Practice Location Address
First Line	:	735 PELHAM PKWY N APT 5T
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-9525
Country	:	US
Telephone Number	:	929-469-9407
Fax Number	:	347-208-4845

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

Provider Enumeration Date	:	07/02/2024
Last Update Date	:	07/02/2024

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