Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 40QA01599800 | NJ |
NPI | 1003297672 |
---|---|
Provider Name | Jason Martinez |
First Address | Clifton, NJ 07012-1453 |
Second Address | Passaic, NJ 07055-4920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2015 |
Last Update Date | 09/06/2015 |