Provider Demographics
NPI:1891403440
Name:MARC, JOVANNA (CPS)
Entity Type:Individual
Prefix:MS
First Name:JOVANNA
Middle Name:
Last Name:MARC
Suffix:
Gender:F
Credentials:CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 ADAM CLAYTON POWELL JR BLVD # 308
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-1743
Mailing Address - Country:US
Mailing Address - Phone:646-975-8895
Mailing Address - Fax:
Practice Address - Street 1:1970 ADAM CLAYTON POWELL JR BLVD # 308
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-1743
Practice Address - Country:US
Practice Address - Phone:646-975-8895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYCPS-2545175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist