Provider Demographics
NPI:1467223016
Name:MARTINEZ ORTIZ, CHRISTOPHER FREDDY A
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:FREDDY A
Last Name:MARTINEZ ORTIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 HOYT AVE S FL 3
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3430
Mailing Address - Country:US
Mailing Address - Phone:718-581-7263
Mailing Address - Fax:
Practice Address - Street 1:2120 HOYT AVE S FL 3
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3430
Practice Address - Country:US
Practice Address - Phone:718-581-7263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07052900104100000X
NY121800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker