Provider Demographics
NPI:1184489254
Name:MARTINEZ, RICARDO JUAN (LMT)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:JUAN
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 BROOKFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-2101
Mailing Address - Country:US
Mailing Address - Phone:631-506-9677
Mailing Address - Fax:
Practice Address - Street 1:41 SUNSET AVE # 11978
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978-2323
Practice Address - Country:US
Practice Address - Phone:631-288-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032655-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty