Active NPI
Jillian Marville, D.P.M
- Podiatrist
- Bronx, NY
National Provider Identifier
1144297417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- N004039-1
- Practice address
- 57-69 West Burnside Avenue
Bronx, NY 10453-4038 - Phone
- (718) 716-4400
- Fax
- (718) 228-7471
- NPI assigned
- Mar 4, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | N004039-1 | NY | Primary |
Addresses
Primary practice location
57-69 West Burnside Avenue
Bronx, NY 10453-4038
Mailing address
85 W Burnside Ave
Bronx, NY 10453-4015
Phone (718) 716-4400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0935828 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004039 | NY | MD | Diagnostic Radiology Physician |
| N004039-1 | NY | MD | Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141430400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1454976000000",
"number": "1144297417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "85 W BURNSIDE AVE",
"city": "BRONX",
"state": "NY",
"postal_code": "104534015",
"telephone_number": "718-716-4400",
"fax_number": "718-228-7471"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "57-69 WEST BURNSIDE AVENUE",
"city": "BRONX",
"state": "NY",
"postal_code": "104534038",
"telephone_number": "718-716-4400",
"fax_number": "718-228-7471"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARVILLE",
"first_name": "JILLIAN",
"credential": "D.P.M",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-04",
"last_updated": "2016-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "NY",
"license": "N004039-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0935828",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.