Provider Demographics
NPI:1144259771
Name:MARTINS, DANIEL (CPO)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:MARTINS
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-3106
Mailing Address - Country:US
Mailing Address - Phone:718-204-5249
Mailing Address - Fax:718-204-5249
Practice Address - Street 1:2204 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-3106
Practice Address - Country:US
Practice Address - Phone:718-204-5249
Practice Address - Fax:718-204-5249
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00616293Medicaid
NY00616293Medicaid