Basic Information
| Provider Information | |||||||||
| NPI: | 1316992522 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | MERCEDES | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 27036 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100877036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123059576 | ||||||||
| FaxNumber: | 2123059480 | ||||||||
| Practice Location | |||||||||
| Address1: | 3959 BROADWAY FL 7 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100321559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123053000 | ||||||||
| FaxNumber: | 2123054343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 04/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080T0004X | 234225 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Transplant Hepatology |
ID Information
| ID | Type | State | Issuer | Description | 02769166 | 05 | NY | MEDICAID |