Provider Demographics
NPI:1376792739
Name:MARX, LISA JOY (DO)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:JOY
Last Name:MARX
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5825
Mailing Address - Country:US
Mailing Address - Phone:631-470-3523
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL RD STE 115
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-8811
Practice Address - Country:US
Practice Address - Phone:631-228-5801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine