Provider Demographics
NPI:1366623670
Name:RICKY J. MARTINO, DC, PLLC
Entity Type:Organization
Organization Name:RICKY J. MARTINO, DC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MARTINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:845-565-0606
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:VAILS GATE
Mailing Address - State:NY
Mailing Address - Zip Code:12584-0142
Mailing Address - Country:US
Mailing Address - Phone:845-565-0606
Mailing Address - Fax:845-569-8805
Practice Address - Street 1:47 OLD TEMPLE HILL RD
Practice Address - Street 2:
Practice Address - City:VAILS GATE
Practice Address - State:NY
Practice Address - Zip Code:12584
Practice Address - Country:US
Practice Address - Phone:845-565-0606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005443-1111N00000X
NY70011071111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX30201Medicare PIN
NYX9L991Medicare PIN