Providence Therapeutics, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

238099 Issued in NY

Legal business name

PROVIDENCE THERAPEUTICS, LLC

Practice address

141 Elm St Apt 3C
Buffalo, NY 14203-2083

Phone

(401) 935-2067

NPI assigned

Oct 17, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Anthony Dunning Martinez, MD

Title

Owner

Phone

(401) 935-2067

Specialties & licenses 1

Addresses

Other names 1

• Providence Therapeutics Doing business as

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

{
    "created_epoch": "1508198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508198400000",
    "number": "1992216907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 ELM ST APT 3C",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142032083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 ELM ST APT 3C",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142032083",
            "telephone_number": "401-935-2067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE THERAPEUTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-17",
        "last_updated": "2017-10-17",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "DUNNING",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "401-935-2067",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "238099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Therapeutics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Proscan Radiology Buffalo PLLC
• Nancy Prospero, NP
• James Prosser
• Meghan Elizabeth Prout, MS
• Ashley Ann Provenzo, FNP
• Tara Andrea Providence, MD
• Janice M Proy, NP
• Amanda A Prus, MSW
• Deborah Prusakowski
• Daniel M Pruski, RPH

• Internal Medicine Physician in Buffalo, NY
• Providers in Buffalo, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2017; 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.