Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 222329 | NY |
NPI | 1083643068 |
---|---|
Provider Name | Robert G Marx |
First Address | New York, NY 10021-4872 |
Second Address | New York, NY 10021-4028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2006 |
Last Update Date | 08/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
453F82 | EMPIRE BLUE CROSS (01) | NY |
P2103456 | OXFORD (01) | NY |