Provider Demographics
NPI:1952570749
Name:MARTES, EDGARDO RAFAEL (PT CKTP)
Entity Type:Individual
Prefix:
First Name:EDGARDO
Middle Name:RAFAEL
Last Name:MARTES
Suffix:
Gender:M
Credentials:PT CKTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 NEWTOWN AVE
Mailing Address - Street 2:211
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1373
Mailing Address - Country:US
Mailing Address - Phone:718-728-2277
Mailing Address - Fax:
Practice Address - Street 1:3109 NEWTOWN AVE
Practice Address - Street 2:211
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1373
Practice Address - Country:US
Practice Address - Phone:718-728-2277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017574225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist