Provider Demographics
NPI:1891989802
Name:MARX, PATRICIA MARY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:MARY
Last Name:MARX
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 ELDER DR
Mailing Address - Street 2:
Mailing Address - City:MASTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11951-5405
Mailing Address - Country:US
Mailing Address - Phone:631-772-2931
Mailing Address - Fax:
Practice Address - Street 1:104 ELDER DR
Practice Address - Street 2:
Practice Address - City:MASTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11951-5405
Practice Address - Country:US
Practice Address - Phone:631-772-2931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-03
Last Update Date:2007-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149671-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01763051Medicaid