1225565864 NPI number — DR. ANA LAURA MARTINEZ-TAPIA MD

Table of content: DR. ANA LAURA MARTINEZ-TAPIA MD (NPI 1225565864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225565864 NPI number — DR. ANA LAURA MARTINEZ-TAPIA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINEZ-TAPIA
Provider First Name:
ANA
Provider Middle Name:
LAURA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1225565864
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 SPRINGVILLE RD STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMPTON BAYS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11946-2290
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-283-5555
Provider Business Mailing Address Fax Number:
631-830-6845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 MEETING HOUSE LANE
Provider Second Line Business Practice Location Address:
BLDG 2 SUITE 405
Provider Business Practice Location Address City Name:
SOUTHAMPTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-283-5555
Provider Business Practice Location Address Fax Number:
631-830-6845
Provider Enumeration Date:
05/14/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  324412 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 112372700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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