Healthcare Provider Details

I. General information

NPI: 1063588036
Provider Name (Legal Business Name): JOANN MARX C.P.O., F.A.A.O.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 MIDDLEVILLE RD PROSTHETIC DEPT. BLD. 200, 4TH FLOOR
NORTHPORT NY
11768-2200
US

IV. Provider business mailing address

1659 LINCOLN AVE
BOHEMIA NY
11716-1415
US

V. Phone/Fax

Practice location:
  • Phone: 631-754-7936
  • Fax: 631-754-7965
Mailing address:
  • Phone: 631-563-1881
  • Fax: 631-563-7237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: