Provider Demographics
NPI:1801157441
Name:MARTINEZ-SOSA, MELEINE MICHELLE
Entity type:Individual
Prefix:
First Name:MELEINE
Middle Name:MICHELLE
Last Name:MARTINEZ-SOSA
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 1:201 STATE RT 17
Mailing Address - Street 2:STE 501
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2669
Mailing Address - Country:US
Mailing Address - Phone:201-457-0044
Mailing Address - Fax:
Practice Address - Street 1:201 STATE RT 17
Practice Address - Street 2:STE 501
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2669
Practice Address - Country:US
Practice Address - Phone:201-457-0044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11305600207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty