Provider Demographics
NPI:1295903938
Name:MARC J. YLAND, M.D. P.C.
Entity type:Organization
Organization Name:MARC J. YLAND, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:YLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-941-0187
Mailing Address - Street 1:2500 NESCONSET HWY
Mailing Address - Street 2:BLDG 24C
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2555
Mailing Address - Country:US
Mailing Address - Phone:631-941-0187
Mailing Address - Fax:631-689-3814
Practice Address - Street 1:2500 NESCONSET HWY
Practice Address - Street 2:BLDG 24C
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2555
Practice Address - Country:US
Practice Address - Phone:631-941-0187
Practice Address - Fax:631-689-3814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWYPWW1Medicare PIN