MEDICARE: DR. JEFFREY LOWELL MARX M.D.

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	207N00000X	Dermatology Physician	134293	NY

General Provider Information

NPI Number	:	1740370816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY LOWELL MARX M.D.

Provider Business Mailing Address
First Line	:	275 MADISON AVE
Second Line	:	SUITE 514
City	:	NEW YORK
State	:	NY
Zip	:	10016-1101
Country	:	US
Telephone Number	:	212-338-0150
Fax Number	:	212-481-9089

Provider Business Practice Location Address
First Line	:	275 MADISON AVE
Second Line	:	SUITE 514
City	:	NEW YORK
State	:	NY
Zip	:	10016-1101
Country	:	US
Telephone Number	:	212-338-0150
Fax Number	:	212-481-9089

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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