Provider Demographics
NPI:1396988473
Name:MARTINEZ, ELBA I
Entity type:Individual
Prefix:
First Name:ELBA
Middle Name:I
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CROSS ST
Mailing Address - Street 2:APT 14A
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-1219
Mailing Address - Country:US
Mailing Address - Phone:914-793-0271
Mailing Address - Fax:
Practice Address - Street 1:50 CROSS ST
Practice Address - Street 2:APT 14A
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-1219
Practice Address - Country:US
Practice Address - Phone:914-793-0271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30304152363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner