Provider Demographics
NPI:1194004713
Name:MARTINEZ, ROSE ELISABETH (RN)
Entity Type:Individual
Prefix:DR
First Name:ROSE
Middle Name:ELISABETH
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 DECKER AVE
Mailing Address - Street 2:SIDE ENTRANCE
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-2114
Mailing Address - Country:US
Mailing Address - Phone:164-630-0197
Mailing Address - Fax:164-630-0197
Practice Address - Street 1:77 DECKER AVE
Practice Address - Street 2:SIDE ENTRANCE
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-2114
Practice Address - Country:US
Practice Address - Phone:164-630-0197
Practice Address - Fax:164-630-0197
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-13
Last Update Date:2011-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5415941101Y00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor