Healthcare Provider Details

I. General information

NPI: 1972185221
Provider Name (Legal Business Name): MATTHEW D MARX DNP, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CAPITAL WAY STE 220
PENNINGTON NJ
08534-2523
US

IV. Provider business mailing address

1120 W TOWNSHIP LINE RD STE 300
HAVERTOWN PA
19083-4930
US

V. Phone/Fax

Practice location:
  • Phone: 609-303-0747
  • Fax:
Mailing address:
  • Phone: 610-601-0760
  • Fax: 610-756-0670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP025538
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01441100
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP211224
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: