Provider Demographics
NPI:1528780475
Name:SALES, MARTHIN MAVERICK CORONADO
Entity type:Individual
Prefix:
First Name:MARTHIN MAVERICK
Middle Name:CORONADO
Last Name:SALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 CATTUS ISLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-3908
Mailing Address - Country:US
Mailing Address - Phone:732-485-2210
Mailing Address - Fax:
Practice Address - Street 1:9 MULE RD STE E5
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5052
Practice Address - Country:US
Practice Address - Phone:732-230-2661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2023-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01368700363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care