Provider Demographics
NPI:1619366317
Name:MARTINEZ, MARIA (PA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 PARTRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-9461
Mailing Address - Country:US
Mailing Address - Phone:856-451-1746
Mailing Address - Fax:
Practice Address - Street 1:53 S LAUREL ST
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-1946
Practice Address - Country:US
Practice Address - Phone:856-451-4700
Practice Address - Fax:856-794-7183
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00358300363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical