Provider Demographics
NPI:1245571306
Name:DAMIAN J. MARTINO MD PC
Entity Type:Organization
Organization Name:DAMIAN J. MARTINO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARTINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-485-1905
Mailing Address - Street 1:2452 44TH ST, B3
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-2060
Mailing Address - Country:US
Mailing Address - Phone:917-485-1905
Mailing Address - Fax:917-456-0437
Practice Address - Street 1:3272 STEINWAY ST
Practice Address - Street 2:SUITE 503
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-4182
Practice Address - Country:US
Practice Address - Phone:917-485-1905
Practice Address - Fax:917-456-0437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-13
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246439208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG100090927OtherMEDICARE PTAN