1770570079 NPI number — LUZ M. MARTIN, M.D. P.C.

Table of content: (NPI 1770570079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770570079 NPI number — LUZ M. MARTIN, M.D. P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUZ M. MARTIN, M.D. P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LUZ M. MARTIN, M.D. & ASSOCIATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770570079
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
94 N ELM ST
Provider Second Line Business Mailing Address:
SUITE # 205
Provider Business Mailing Address City Name:
WESTFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01085-1647
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-568-0850
Provider Business Mailing Address Fax Number:
413-562-1476

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
94 N ELM ST
Provider Second Line Business Practice Location Address:
SUITE # 205
Provider Business Practice Location Address City Name:
WESTFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01085-1647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-568-0850
Provider Business Practice Location Address Fax Number:
413-562-1476
Provider Enumeration Date:
10/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
LUZ
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
413-568-0850

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  77442 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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