Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 012267-1 | NY |
NPI | 1144462011 |
---|---|
Provider Name | Ms. Colleen Joy Marx |
First Address | Tonawanda, NY 14150-7970 |
Second Address | Tonawanda, NY 14150-7970 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2009 |
Last Update Date | 24/03/2009 |