Healthcare Provider Details

I. General information

NPI: 1417124777
Provider Name (Legal Business Name): CHRISTINE MARGIT MARSHALL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 07/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL
NEW YORK NY
10029-6500
US

IV. Provider business mailing address

133 WILLOW AVE
HACKENSACK NJ
07601-3051
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-8095
  • Fax:
Mailing address:
  • Phone: 201-489-7649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number303406
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: