Provider Demographics
NPI:1033173745
Name:MARTINEZ DIAZ, ELISAMUEL
Entity type:Individual
Prefix:DR
First Name:ELISAMUEL
Middle Name:
Last Name:MARTINEZ DIAZ
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 1:10 DAVENPORT AVE BSMT
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-3634
Mailing Address - Country:US
Mailing Address - Phone:787-396-0975
Mailing Address - Fax:
Practice Address - Street 1:10 DAVENPORT AVE BSMT
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10805-3634
Practice Address - Country:US
Practice Address - Phone:787-396-0975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2559103TC0700X
NY024087103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical