Healthcare Provider Details

I. General information

NPI: 1710240213
Provider Name (Legal Business Name): JOANNE MARMOL-MARMOLEJOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CENTEROCK RD
WEST NYACK NY
10994-2215
US

IV. Provider business mailing address

PO BOX 411730
BOSTON MA
02241-1730
US

V. Phone/Fax

Practice location:
  • Phone: 845-703-6999
  • Fax: 845-703-6297
Mailing address:
  • Phone: 845-703-6999
  • Fax: 845-703-6297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA10703700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number340695
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: