Provider Demographics
NPI:1194567305
Name:MARTINEZ, SAMANTHA LEE (APN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LEE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 MAIN ST APT 314
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-7371
Mailing Address - Country:US
Mailing Address - Phone:201-723-0969
Mailing Address - Fax:
Practice Address - Street 1:1 W RIDGEWOOD AVE STE 302
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2361
Practice Address - Country:US
Practice Address - Phone:201-975-5363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15081200363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty