Provider Demographics
NPI:1073288148
Name:MARTINEZ, SANDRA MILENA
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MILENA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DANFORTH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-1619
Mailing Address - Country:US
Mailing Address - Phone:718-503-2349
Mailing Address - Fax:
Practice Address - Street 1:5107 108TH ST REAR UNIT
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3304
Practice Address - Country:US
Practice Address - Phone:929-437-2020
Practice Address - Fax:929-437-2022
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010173156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty