=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881255370
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARC J YUNIS MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2019
-----------------------------------------------------
Last Update Date | 06/25/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 STEWART AVE STE 2
-----------------------------------------------------
City | GARDEN CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11530-4839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-695-2248
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30 DEERPATH
-----------------------------------------------------
City | ROSLYN HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11577-1602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-695-2248
-----------------------------------------------------
Fax | 516-621-2823
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | MARC YUNIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-695-2248
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------