Provider Demographics
NPI:1033321880
Name:DR. DANTE MARTINEZ
Entity Type:Organization
Organization Name:DR. DANTE MARTINEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-281-3590
Mailing Address - Street 1:25 MULE RD
Mailing Address - Street 2:SUITE B-2
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5035
Mailing Address - Country:US
Mailing Address - Phone:732-281-3590
Mailing Address - Fax:732-281-0054
Practice Address - Street 1:25 MULE RD
Practice Address - Street 2:SUITE B-2
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5035
Practice Address - Country:US
Practice Address - Phone:732-281-3590
Practice Address - Fax:732-281-0054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA27512207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2168901Medicaid
NJ2168901Medicaid
NJC53890Medicare UPIN
NJ199304Medicare ID - Type Unspecified