Provider Demographics
NPI:1205196573
Name:MARTINEZ, TIFFANY ANNMARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:ANNMARIE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:ANNMARIE
Other - Last Name:TERRELONGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:20 CIVIC CENTER DR
Mailing Address - Street 2:APT 4
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3567
Mailing Address - Country:US
Mailing Address - Phone:732-841-0851
Mailing Address - Fax:
Practice Address - Street 1:901 W MAIN ST FL 2
Practice Address - Street 2:SUITE 240
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2537
Practice Address - Country:US
Practice Address - Phone:732-308-2255
Practice Address - Fax:732-394-6432
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09325500207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology