Provider Demographics
NPI:1588818918
Name:MARQUEZ, JAIME M (DPT)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:M
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 PARK AVE
Mailing Address - Street 2:# 17 B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1735
Mailing Address - Country:US
Mailing Address - Phone:646-719-1391
Mailing Address - Fax:
Practice Address - Street 1:1245 PARK AVE
Practice Address - Street 2:# 17 B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1735
Practice Address - Country:US
Practice Address - Phone:646-719-1391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030157225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist