Provider Demographics
NPI:1033130729
Name:YANEZ, MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:
Last Name:YANEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25 GLEN RIDGE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-3641
Mailing Address - Country:US
Mailing Address - Phone:312-286-5360
Mailing Address - Fax:866-416-4228
Practice Address - Street 1:25 GLEN RIDGE RD # 31155
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-3641
Practice Address - Country:US
Practice Address - Phone:312-286-5360
Practice Address - Fax:866-416-4228
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2076292085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH34733Medicare UPIN