MEDICARE: JILL MARX NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	311077	NY

General Provider Information

NPI Number	:	1225748676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL MARX NP

Provider Business Mailing Address
First Line	:	23 MANOR LN
Second Line	:
City	:	LARCHMONT
State	:	NY
Zip	:	10538-3613
Country	:	US
Telephone Number	:	513-659-4546
Fax Number	:

Provider Business Practice Location Address
First Line	:	455 N END AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10282-1131
Country	:	US
Telephone Number	:	212-489-8800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2022
Last Update Date	:	11/28/2022

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