Provider Demographics
NPI:1730481979
Name:YMAZ, MARY ROSE (CPNP)
Entity Type:Individual
Prefix:MS
First Name:MARY ROSE
Middle Name:
Last Name:YMAZ
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6861 YELLOWSTONE BLVD
Mailing Address - Street 2:APT. 311
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-9403
Mailing Address - Country:US
Mailing Address - Phone:917-379-6700
Mailing Address - Fax:
Practice Address - Street 1:1486 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-1214
Practice Address - Country:US
Practice Address - Phone:929-455-9781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381971363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics