Provider Demographics
NPI:1225109671
Name:MARTINEZ, LUIS E SR (DR OF MED & SURGERY)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:E
Last Name:MARTINEZ
Suffix:SR
Gender:M
Credentials:DR OF MED & SURGERY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 EMORY RD
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501
Mailing Address - Country:US
Mailing Address - Phone:516-741-4669
Mailing Address - Fax:516-741-4697
Practice Address - Street 1:251 EMORY RD
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501
Practice Address - Country:US
Practice Address - Phone:516-741-4669
Practice Address - Fax:516-741-4697
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131999208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00379117Medicaid
NY00379117Medicaid