Provider Demographics
NPI:1700202629
Name:LISA MARX, DO, PLLC
Entity Type:Organization
Organization Name:LISA MARX, DO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:MARX
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-868-7200
Mailing Address - Street 1:859 MONTAUK HWY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-1634
Mailing Address - Country:US
Mailing Address - Phone:631-868-7200
Mailing Address - Fax:631-868-7199
Practice Address - Street 1:859 MONTAUK HWY
Practice Address - Street 2:SUITE 3
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-1634
Practice Address - Country:US
Practice Address - Phone:631-868-7200
Practice Address - Fax:631-868-7199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195270261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG06310Medicare UPIN