Provider Demographics
NPI:1053400838
Name:MARTINS, CARLOS ANIBAL (OTRIL CHT)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:ANIBAL
Last Name:MARTINS
Suffix:
Gender:M
Credentials:OTRIL CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 NORTHERN BLVD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4311
Mailing Address - Country:US
Mailing Address - Phone:516-504-4263
Mailing Address - Fax:718-281-4263
Practice Address - Street 1:107 NORTHERN BLVD
Practice Address - Street 2:SUITE 308
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4311
Practice Address - Country:US
Practice Address - Phone:516-504-4263
Practice Address - Fax:718-281-4263
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007678225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
043G2GMedicare ID - Type Unspecified