Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 179860 | NY |
NPI | 1619072154 |
---|---|
Provider Name | Jose A Martinez |
First Address | Cornwall, NY 12518-1370 |
Second Address | Newburgh, NY 12550-5306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 24/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01317660 | (05) | NY |
F21590 | (02) | NY |