Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
N | 224P00000X | Prosthetist |
NPI | 1063588036 |
---|---|
Provider Name | Ms. Joann Marx |
First Address | Bohemia, NY 11716-1415 |
Second Address | Northport, NY 11768-2200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 08/07/2007 |