Provider Demographics
NPI:1003877143
Name:MARTINEZ, HOMAR A (MD)
Entity Type:Individual
Prefix:DR
First Name:HOMAR
Middle Name:A
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 NEWMANS LN
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08836-2139
Mailing Address - Country:US
Mailing Address - Phone:732-764-9392
Mailing Address - Fax:732-764-9392
Practice Address - Street 1:775 MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-6262
Practice Address - Country:US
Practice Address - Phone:908-561-1102
Practice Address - Fax:908-561-1105
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA074281207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA074281OtherLICENSE
NJ0096512Medicaid
NJF31122Medicare UPIN
NJ097210Medicare ID - Type Unspecified