Provider Demographics
NPI:1851368542
Name:MARTINEZ, DANTE B (MD)
Entity Type:Individual
Prefix:
First Name:DANTE
Middle Name:B
Last Name:MARTINEZ
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 1:25 MULE ROAD
Mailing Address - Street 2:SUITE B-2
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755
Mailing Address - Country:US
Mailing Address - Phone:732-244-4004
Mailing Address - Fax:732-244-4005
Practice Address - Street 1:25 MULE ROAD
Practice Address - Street 2:SUITE B-2
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755
Practice Address - Country:US
Practice Address - Phone:732-244-4004
Practice Address - Fax:732-244-4005
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02751200207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2168901Medicaid
C53890Medicare UPIN
NJ199304Medicare ID - Type Unspecified