Provider Demographics
NPI:1235400656
Name:JUAN YAMIN MD PC
Entity Type:Organization
Organization Name:JUAN YAMIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LENIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FERMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-781-1900
Mailing Address - Street 1:PO BOX 763
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-0594
Mailing Address - Country:US
Mailing Address - Phone:212-781-1900
Mailing Address - Fax:646-417-5959
Practice Address - Street 1:629 W 185TH ST
Practice Address - Street 2:BSMT
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3102
Practice Address - Country:US
Practice Address - Phone:212-781-1900
Practice Address - Fax:646-417-5959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0940891174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty