Provider Demographics
NPI:1730267386
Name:MARTINEZ, SUSAN TRACY (RPA-C)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:TRACY
Last Name:MARTINEZ
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Gender:F
Credentials:RPA-C
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Mailing Address - Street 1:210 E 64TH ST FL 4
Mailing Address - Street 2:INSALL SCOTT KELLY INSTITUTE FOR ORTHOPAEDICS AND SPORT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7471
Mailing Address - Country:US
Mailing Address - Phone:646-293-7501
Mailing Address - Fax:646-293-7502
Practice Address - Street 1:210 E 64TH ST
Practice Address - Street 2:4TH FLOOR- INSALL SCOTT KELLY INSTITUTE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7471
Practice Address - Country:US
Practice Address - Phone:646-293-7501
Practice Address - Fax:646-293-7502
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2011-12-15
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Provider Licenses
StateLicense IDTaxonomies
NY006491363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006491OtherLICENSE NUMBER