Provider Demographics
NPI:1124278791
Name:MARTINEZ, JOHN P (CRNA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 12023
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-5023
Mailing Address - Country:US
Mailing Address - Phone:212-427-2666
Mailing Address - Fax:212-289-6929
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:ANESTHESIOLOGY - BOX 1010
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6500
Practice Address - Country:US
Practice Address - Phone:800-627-4470
Practice Address - Fax:412-937-5710
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2013-05-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY586088-1367500000X
NJ26NO12302900367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered