Healthcare Provider Details

I. General information

NPI: 1477556025
Provider Name (Legal Business Name): MARC YLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NESCONSET HWY BLDG 24C
STONY BROOK NY
11790-2598
US

IV. Provider business mailing address

2500 NESCONSET HWY BLDG 24C
STONY BROOK NY
11790-2598
US

V. Phone/Fax

Practice location:
  • Phone: 631-941-0187
  • Fax: 631-689-3814
Mailing address:
  • Phone: 631-941-0187
  • Fax: 631-689-3814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number185247
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number185247
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: