Provider Demographics
NPI:1427463611
Name:MARTINEZ, KARIN
Entity type:Individual
Prefix:
First Name:KARIN
Middle Name:
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 1:4135 48TH ST
Mailing Address - Street 2:APT. 1R
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-1525
Mailing Address - Country:US
Mailing Address - Phone:917-623-4196
Mailing Address - Fax:
Practice Address - Street 1:4135 48TH ST
Practice Address - Street 2:APT. 1R
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-1525
Practice Address - Country:US
Practice Address - Phone:917-623-4196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58023495235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist