Healthcare Provider Details

I. General information

NPI: 1407924095
Provider Name (Legal Business Name): CHRISTA M MARCO APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

468 PARISH DR SUITE 6
WAYNE NY
07470
US

IV. Provider business mailing address

468 PARISH DR SUITE 6
WAYNE NJ
07470-4671
US

V. Phone/Fax

Practice location:
  • Phone: 973-686-2777
  • Fax: 973-686-2780
Mailing address:
  • Phone: 973-305-8300
  • Fax: 973-305-8157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNJ00093500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: