Provider Demographics
NPI:1316992522
Name:MARTINEZ, MERCEDES (MD)
Entity type:Individual
Prefix:DR
First Name:MERCEDES
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27036
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-7036
Mailing Address - Country:US
Mailing Address - Phone:212-305-9576
Mailing Address - Fax:212-305-9480
Practice Address - Street 1:3959 BROADWAY FL 7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1559
Practice Address - Country:US
Practice Address - Phone:212-305-3000
Practice Address - Fax:212-305-4343
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2342252080T0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080T0004XAllopathic & Osteopathic PhysiciansPediatricsPediatric Transplant Hepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02769166Medicaid
NYA400087811Medicare PIN