MEDICARE: MS. MARY ROSE YMAZ CPNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	F381971	NY

General Provider Information

NPI Number	:	1730481979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY ROSE YMAZ CPNP

Provider Business Mailing Address
First Line	:	6861 YELLOWSTONE BLVD
Second Line	:	APT. 311
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-9403
Country	:	US
Telephone Number	:	917-379-6700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1486 DEER PARK AVE
Second Line	:
City	:	BABYLON
State	:	NY
Zip	:	11703-1214
Country	:	US
Telephone Number	:	929-455-9781
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2010
Last Update Date	:	09/12/2022

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