Provider Demographics
NPI:1396204715
Name:MARTINEZ, DAVID NON (COMMERCIAL DRIVER)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:NON
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:COMMERCIAL DRIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1933 GREENVILLE TNPK
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS, NY, USA
Mailing Address - State:NY
Mailing Address - Zip Code:12771-3264
Mailing Address - Country:US
Mailing Address - Phone:845-820-4989
Mailing Address - Fax:845-856-2859
Practice Address - Street 1:1933 GREENVILLE TNPK
Practice Address - Street 2:
Practice Address - City:PORT JERVIS, NY, USA
Practice Address - State:NY
Practice Address - Zip Code:12771-3264
Practice Address - Country:US
Practice Address - Phone:845-820-4989
Practice Address - Fax:845-856-2859
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY846396XXX172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty