Provider Demographics
NPI:1972190528
Name:MARTYNOV, ANDREY
Entity Type:Individual
Prefix:
First Name:ANDREY
Middle Name:
Last Name:MARTYNOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 OCEAN AVE APT D6
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3921
Mailing Address - Country:US
Mailing Address - Phone:939-327-6360
Mailing Address - Fax:
Practice Address - Street 1:15 NEWARK AVE STE 2
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-1123
Practice Address - Country:US
Practice Address - Phone:732-844-9220
Practice Address - Fax:732-844-9221
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist