Provider Demographics
NPI:1750631891
Name:MARC JANIS MD PLLC
Entity Type:Organization
Organization Name:MARC JANIS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:C
Authorized Official - Last Name:JANIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-664-7311
Mailing Address - Street 1:150 STEVENS AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2596
Mailing Address - Country:US
Mailing Address - Phone:914-664-7311
Mailing Address - Fax:914-664-2530
Practice Address - Street 1:150 STEVENS AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2596
Practice Address - Country:US
Practice Address - Phone:914-664-7311
Practice Address - Fax:914-664-2530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty