1063588036 NPI number — JOANN MARX C.P.O., F.A.A.O.P

NPI Number: 1063588036
Health Care Provider/Practitioner: JOANN MARX C.P.O., F.A.A.O.P

NPI Number : 1063588036 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1063588036",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MARX",
    "FirstName": "JOANN",
    "MiddleName": null,
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "C.P.O., F.A.A.O.P",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1659 LINCOLN AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BOHEMIA",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11716-1415",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "631-563-1881",
    "MailingAddressFaxNumber": "631-563-7237",
    "FirstLinePracticeLocationAddress": "79 MIDDLEVILLE RD",
    "SecondLinePracticeLocationAddress": "PROSTHETIC DEPT. BLD. 200, 4TH FLOOR",
    "PracticeLocationAddressCityName": "NORTHPORT",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "11768-2200",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "631-754-7936",
    "PracticeLocationAddressFaxNumber": "631-754-7965",
    "EnumerationDate": "11/28/2006",
    "LastUpdateDate": "09/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "222Z00000X",
          "TaxonomyName": "Orthotist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "224P00000X",
          "TaxonomyName": "Prosthetist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}