Provider Demographics
NPI:1396176533
Name:MARTINEZ, IAN (MD)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:
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 1:6 CLUB HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-2212
Mailing Address - Country:US
Mailing Address - Phone:908-237-4144
Mailing Address - Fax:908-237-4137
Practice Address - Street 1:6 CLUB HOUSE DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-2212
Practice Address - Country:US
Practice Address - Phone:908-237-4144
Practice Address - Fax:908-237-4137
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09730600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ508872Medicare PIN