Provider Demographics
NPI:1700828092
Name:MARTINEZ DE PIMENTEL, NADIA A (MD)
Entity Type:Individual
Prefix:DR
First Name:NADIA
Middle Name:A
Last Name:MARTINEZ DE PIMENTEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3744 75TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6423
Mailing Address - Country:US
Mailing Address - Phone:718-672-6232
Mailing Address - Fax:718-672-5817
Practice Address - Street 1:3744 75TH ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6423
Practice Address - Country:US
Practice Address - Phone:718-672-6232
Practice Address - Fax:718-672-5817
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2067951207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01775144Medicaid
NY05165JMedicare PIN
NY01775144Medicaid