Provider Demographics
NPI:1902869555
Name:RIVERA MARTINEZ, SONIA (DO)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:RIVERA MARTINEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 CARLETON AVE
Mailing Address - Street 2:FAMILY HEALTH CARE CENTER, NY INSTITUTE OF TECHNOLOGY
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-4543
Mailing Address - Country:US
Mailing Address - Phone:631-348-3254
Mailing Address - Fax:631-348-3031
Practice Address - Street 1:267 CARLETON AVE
Practice Address - Street 2:FAMILY HEALTH CARE CENTER, NY INSTITUTE OF TECHNOLOGY
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-4543
Practice Address - Country:US
Practice Address - Phone:631-348-3254
Practice Address - Fax:631-348-3031
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY229958207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2330P33531Medicare PIN
I28507Medicare UPIN
NY2330P1Medicare PIN