Provider Demographics
NPI:1811975519
Name:MARTINEZ, GRACIANI (DPM)
Entity type:Individual
Prefix:DR
First Name:GRACIANI
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 W BLACKWELL ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-2520
Mailing Address - Country:US
Mailing Address - Phone:973-366-8000
Mailing Address - Fax:973-442-1300
Practice Address - Street 1:387 W BLACKWELL ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-2520
Practice Address - Country:US
Practice Address - Phone:973-366-8000
Practice Address - Fax:973-442-1300
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00276200213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0046710Medicaid
NJU94508Medicare UPIN
NJ073562Medicare ID - Type Unspecified