Healthcare Provider Details

I. General information

NPI: 1871642751
Provider Name (Legal Business Name): CHRISTINE MARX-GERMANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1193 TERRY RD
RONKONKOMA NY
11779-5946
US

IV. Provider business mailing address

1193 TERRY RD
RONKONKOMA NY
11779-5946
US

V. Phone/Fax

Practice location:
  • Phone: 516-838-1020
  • Fax:
Mailing address:
  • Phone: 516-838-1020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number055911
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: