Provider Demographics
NPI:1649960758
Name:MARTINEZ, JUAN JR
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:MARTINEZ
Suffix:JR
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 1:12 MIDDLESEX BLVD
Mailing Address - Street 2:
Mailing Address - City:KEYPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07735-6052
Mailing Address - Country:US
Mailing Address - Phone:732-977-8778
Mailing Address - Fax:
Practice Address - Street 1:111 NJ ROUTE 35S
Practice Address - Street 2:
Practice Address - City:CLIFFWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07721
Practice Address - Country:US
Practice Address - Phone:732-812-5489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR14061700163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)