1063588036 NPI number — MS. JOANN MARX C.P.O., F.A.A.O.P

Table of content: MS. JOANN MARX C.P.O., F.A.A.O.P (NPI 1063588036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063588036 NPI number — MS. JOANN MARX C.P.O., F.A.A.O.P

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARX
Provider First Name:
JOANN
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
C.P.O., F.A.A.O.P
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063588036
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1659 LINCOLN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOHEMIA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11716-1415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-563-1881
Provider Business Mailing Address Fax Number:
631-563-7237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
79 MIDDLEVILLE RD
Provider Second Line Business Practice Location Address:
PROSTHETIC DEPT. BLD. 200, 4TH FLOOR
Provider Business Practice Location Address City Name:
NORTHPORT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11768-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-754-7936
Provider Business Practice Location Address Fax Number:
631-754-7965
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 222Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 224P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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