Healthcare Provider Details

I. General information

NPI: 1184447070
Provider Name (Legal Business Name): MARINA YANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 OLD MARLTON PIKE STE 124
MEDFORD NJ
08055-8772
US

IV. Provider business mailing address

83 WHITFORD DR
BURLINGTON NJ
08016-4359
US

V. Phone/Fax

Practice location:
  • Phone: 888-575-9162
  • Fax:
Mailing address:
  • Phone: 609-251-2445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ15203500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: