Provider Demographics
NPI:1295559904
Name:MARTINEZ, KATRINA ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:ELIZABETH
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HERDMAN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10993-1408
Mailing Address - Country:US
Mailing Address - Phone:646-737-6661
Mailing Address - Fax:
Practice Address - Street 1:221 W GRAND AVE STE 201
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1729
Practice Address - Country:US
Practice Address - Phone:845-694-7570
Practice Address - Fax:845-212-2730
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-09
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01506500225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist