Provider Demographics
NPI:1952658551
Name:PHILLIPPE MARTINEAU MD. INC
Entity Type:Organization
Organization Name:PHILLIPPE MARTINEAU MD. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIPPE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-844-6005
Mailing Address - Street 1:2151 45TH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2015
Mailing Address - Country:US
Mailing Address - Phone:561-844-6005
Mailing Address - Fax:561-844-0056
Practice Address - Street 1:2151 45TH ST STE 210
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2015
Practice Address - Country:US
Practice Address - Phone:561-844-6005
Practice Address - Fax:561-844-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00074365251S00000X, 276400000X, 293D00000X, 302R00000X, 310400000X, 313M00000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251S00000XAgenciesCommunity/Behavioral Health
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No293D00000XLaboratoriesPhysiological Laboratory
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE0853Medicare PIN
G38353Medicare UPIN