Provider Demographics
NPI:1912732199
Name:MARTINEZ, ELMER
Entity type:Individual
Prefix:
First Name:ELMER
Middle Name:
Last Name:MARTINEZ
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 1:2 SPRUCE ST APT 2J
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3808
Mailing Address - Country:US
Mailing Address - Phone:516-813-5836
Mailing Address - Fax:
Practice Address - Street 1:2 SPRUCE ST APT 2J
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3808
Practice Address - Country:US
Practice Address - Phone:516-813-5836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician