Provider Demographics
NPI:1578376489
Name:MARTINEZ, EMMANUEL (LMT)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 WILLOUGHBY AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-7557
Mailing Address - Country:US
Mailing Address - Phone:718-844-9196
Mailing Address - Fax:
Practice Address - Street 1:161 WATER ST FL 23
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4972
Practice Address - Country:US
Practice Address - Phone:917-595-6216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033607225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist