Provider Demographics
NPI:1811161169
Name:MARTINEZ, ANTHONY (MASTER'S PT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MASTER'S PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1221 JEROME AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452
Mailing Address - Country:US
Mailing Address - Phone:718-538-8343
Mailing Address - Fax:833-347-3373
Practice Address - Street 1:1221 JEROME AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452
Practice Address - Country:US
Practice Address - Phone:718-538-8343
Practice Address - Fax:833-347-3373
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY030139225100000X
NY030139-1225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist