Provider Demographics
NPI:1033197702
Name:MARTINEZ, MIGUEL F (DC)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:F
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20507 HILLSIDE AVE
Mailing Address - Street 2:SUITE 19
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2220
Mailing Address - Country:US
Mailing Address - Phone:718-468-1234
Mailing Address - Fax:718-468-4003
Practice Address - Street 1:20507 HILLSIDE AVE
Practice Address - Street 2:SUITE 19
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2220
Practice Address - Country:US
Practice Address - Phone:718-468-1234
Practice Address - Fax:718-468-4003
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02158327Medicaid
NY03201Medicare ID - Type Unspecified