Physician Compare National (NPI:1669587879)

HEALTHCARE PROVIDER: MARC CHARLES JANIS MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1669587879
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5092867135
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090721000070
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	JANIS
	Individual professional last name
Provider First Name	MARC
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	ALBERT EINSTEIN COLLEGE OF MEDICINE OF YESHIVA UNIVERSITY
	Individual professional's medical school
Graduation Year	1986
	Individual professional's medical school graduation year
Primary Specialty	UROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	105 STEVENS AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 109
	Group Practice or individual's line 2 address
City	MOUNT VERNON
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	105502682
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	330208
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST JOHN'S RIVERSIDE HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	330086
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MONTEFIORE MOUNT VERNON HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	330059
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	MONTEFIORE MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	330006
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	ST JOSEPH'S MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y