Provider Information for 1356094064
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KEN J MARTZ
Sex: Male
NPI: 1356094064
Last Updated: 2022-02-02
Certification Date: 2022-02-02
Certification Date: 2022-02-02
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1356094064 | ||||||||
| Enumeration Date | 2022-02-02 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 4025 KILLINGTON CT EAGLEVILLE, PA 19403-1224 United States Phone: 484-704-0003 | Fax: | ||||||||
| Primary Practice Address | 4025 KILLINGTON CT EAGLEVILLE, PA 19403-1224 United States Phone: 484-704-0003 | Fax: | ||||||||
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