Provider Demographics
NPI:1639229974
Name:MARMOL, JOSE Y (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:Y
Last Name:MARMOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3105
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07303-3105
Mailing Address - Country:US
Mailing Address - Phone:201-435-6675
Mailing Address - Fax:201-435-7610
Practice Address - Street 1:172 NEWARK AVENUE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302
Practice Address - Country:US
Practice Address - Phone:201-435-6675
Practice Address - Fax:201-435-7610
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05186800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJHUL00000600OtherAMERICHOICE
NJ3951103Medicaid
NJ1041321OtherHORIZON HEALTH
E22022Medicare UPIN
NJ3951103Medicaid