Provider Demographics
NPI:1336171040
Name:MARTINEZ, SERGIO
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:
Last Name:MARTINEZ
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 SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3941
Mailing Address - Country:US
Mailing Address - Phone:718-446-4544
Mailing Address - Fax:
Practice Address - Street 1:3711 88TH ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7630
Practice Address - Country:US
Practice Address - Phone:718-446-4544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181742207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE74477Medicare UPIN
NY01256317Medicare ID - Type Unspecified
NY02227Medicare ID - Type Unspecified