Provider Demographics
NPI:1336221241
Name:MARTINEZ, FERNANDO J (MD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:J
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 YORK AVENUE
Mailing Address - Street 2:ROOM Y-1059, BOX 96
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:646-962-2730
Mailing Address - Fax:
Practice Address - Street 1:525 EAST 68TH STREET
Practice Address - Street 2:PULMONARY AND CRITICAL CARE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:646-962-2730
Practice Address - Fax:646-962-0286
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058718207R00000X, 207RC0200X, 207RP1001X
NY276707207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2791826Medicaid
MI2791826Medicaid
MIB74770Medicare UPIN