Provider Demographics
NPI:1790850006
Name:JOSE Y MARMOL PC
Entity Type:Organization
Organization Name:JOSE Y MARMOL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:YUZON
Authorized Official - Last Name:MARMOL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:201-435-6675
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05186800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3951103Medicaid
NJ1041321OtherHORIZON NJ HEALTH
NJHUL00000600OtherAMERI CHOICE