Individual
IAN MARTINEZ GAMPON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7901 BROADWAY, ROOM A1-9, ELMHURST, NY 11373-1329
(718) 334-4952
(718) 334-4815
Mailing address
7901 BROADWAY, ROOM A1-9, ELMHURST, NY 11373-1329
(718) 334-4952
(718) 334-4815
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
227500
NY
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
227500
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02408804
—
NY
Enumeration date
06/29/2006
Last updated
10/23/2007
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