Provider Demographics
NPI:1982075248
Name:MARTINEZ, BRIAN ALBERTO (LPN)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ALBERTO
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SPLIT CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-1615
Mailing Address - Country:US
Mailing Address - Phone:631-903-0609
Mailing Address - Fax:
Practice Address - Street 1:40 SPLIT CEDAR DR
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-1615
Practice Address - Country:US
Practice Address - Phone:631-903-0609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY323713164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse