Provider Demographics
NPI:1982075248
Name:MARTINEZ, BRIAN ALBERTO (RN)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ALBERTO
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 BERGOLD ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-5042
Mailing Address - Country:US
Mailing Address - Phone:631-790-7468
Mailing Address - Fax:
Practice Address - Street 1:137 BERGOLD ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-5042
Practice Address - Country:US
Practice Address - Phone:631-790-7468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY323713164W00000X
NY925368163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse