Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 25MA074281 | NJ |
N | 111NI0900X | Internist | 25MA074281 | NJ |
Y | 207RI0200X | Infectious Disease | 25MA074281 | NJ |
NPI | 1003877143 |
---|---|
Provider Name | Dr. Homar A Martinez |
First Address | Martinsville, NJ 08836-2139 |
Second Address | Watchung, NJ 07069-6262 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2006 |
Last Update Date | 13/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0096512 | (05) | NJ |
25MA074281 | LICENSE (01) | NJ |
F31122 | (02) | NJ |