Provider Demographics
NPI:1891817649
Name:MARTIN, JENNIFER REYES (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:REYES
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W 72ND ST
Mailing Address - Street 2:APT. 804
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4100
Mailing Address - Country:US
Mailing Address - Phone:917-697-1756
Mailing Address - Fax:
Practice Address - Street 1:25 W 68TH ST
Practice Address - Street 2:STE. 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5302
Practice Address - Country:US
Practice Address - Phone:212-579-8885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050334-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice