MEDICARE: AQUILAH MARTINEZ LPN

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	164W00000X	Licensed Practical Nurse	270352	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982731493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AQUILAH MARTINEZ LPN

Provider Business Mailing Address
First Line	:	35 TULIP AVENUE
Second Line	:
City	:	FLORAL PARK
State	:	NY
Zip	:	11002-0838
Country	:	US
Telephone Number	:	917-862-5215
Fax Number	:	718-347-4643

Provider Business Practice Location Address
First Line	:	75 LIBERTY AVE APT 82
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-5032
Country	:	US
Telephone Number	:	917-862-5215
Fax Number	:	718-347-4643

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/09/2007

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