Individual provider Active NPI

Jessica Marie Martino

  • Student in an Organized Health Care Education/Training Program
  • Doral, FL
National Provider Identifier
1679274260
Registry record updated Jan 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
3601 NW 107TH Ave FL 3
Doral, FL 33178-4377
Phone
(305) 418-7771
NPI assigned
Mar 13, 2023
Last updated
Jan 26, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 26, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 063906 NY
Student in an Organized Health Care Education/Training Program 390200000X NU Primary

Addresses

Primary practice location

3601 NW 107TH Ave FL 3
Doral, FL 33178-4377

Mailing address

16008 88TH St
Howard Beach, NY 11414-3038

Other practice location 1

640 Fulton St Ste 3
Farmingdale, NY 11735-3460
Phone (516) 694-2106

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
063906NYMDPharmacy

Practice roles

OrganizationSpecialtyStatusNew patients
Nicklaus Children's Hospital Student in an Organized Health Care Education/Training Program PastSince Feb 2, 2025 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769385600000",
    "number": "1679274260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16008 88TH ST",
            "city": "HOWARD BEACH",
            "state": "NY",
            "postal_code": "114143038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 NW 107TH AVE FL 3",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331784377",
            "telephone_number": "305-418-7771"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "640 Fulton St Ste 3",
            "address_purpose": "LOCATION",
            "city": "Farmingdale",
            "state": "NY",
            "postal_code": "117353460",
            "country_code": "US",
            "telephone_number": "516-694-2106",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTINO",
        "first_name": "JESSICA",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-13",
        "last_updated": "2026-01-26",
        "certification_date": "2026-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "063906",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Doral, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.