MEDICARE: LUIS MARTINEZ MS. ED.

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	103TS0200X	School Psychologist	221796031	NY

General Provider Information

NPI Number	:	1679823009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS MARTINEZ MS. ED.

Provider Business Mailing Address
First Line	:	1511 E 172ND ST
Second Line	:	APARTMENT 1-R
City	:	BRONX
State	:	NY
Zip	:	10472-2154
Country	:	US
Telephone Number	:	917-538-6519
Fax Number	:

Provider Business Practice Location Address
First Line	:	1511 E 172ND ST
Second Line	:	APARTMENT 1-R
City	:	BRONX
State	:	NY
Zip	:	10472-2154
Country	:	US
Telephone Number	:	917-538-6519
Fax Number	:

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

Provider Enumeration Date	:	09/13/2012
Last Update Date	:	09/13/2012

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