Provider Demographics
NPI:1093837189
Name:MARTINEZ SERGIO, CARMEN IRIS (MS, LAC, DIPLAC)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:IRIS
Last Name:MARTINEZ SERGIO
Suffix:
Gender:F
Credentials:MS, LAC, DIPLAC
Other - Prefix:
Other - First Name:IRIS
Other - Middle Name:
Other - Last Name:SERGIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LAC,DIPLAC
Mailing Address - Street 1:26715 83RD AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1733
Mailing Address - Country:US
Mailing Address - Phone:516-642-5762
Mailing Address - Fax:
Practice Address - Street 1:26715 83RD AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11004-1733
Practice Address - Country:US
Practice Address - Phone:516-642-5762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3006171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist