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Individual

JILLIAN MARVILLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
D.P.M

Contact information

Practice address
57-69 WEST BURNSIDE AVENUE, BRONX, NY 10453-4038
(718) 716-4400
(718) 228-7471
Mailing address
85 W BURNSIDE AVE, BRONX, NY 10453-4015
(718) 716-4400
(718) 228-7471

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
N004039-1
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0935828
NY
Enumeration date
03/04/2006
Last updated
02/09/2016
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