Provider Demographics
NPI:1710926001
Name:MARTINELLI, DONALD (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:MARTINELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 85TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3310
Mailing Address - Country:US
Mailing Address - Phone:718-833-6161
Mailing Address - Fax:718-491-3483
Practice Address - Street 1:8306 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3018
Practice Address - Country:US
Practice Address - Phone:718-833-6161
Practice Address - Fax:718-491-3483
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187901207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01516976Medicaid
NY33J121Medicare PIN
NY01516976Medicaid