Provider Demographics
NPI:1700584869
Name:YUNUS, KINTAN MAURA
Entity Type:Individual
Prefix:
First Name:KINTAN
Middle Name:MAURA
Last Name:YUNUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 TEMPLE ST # 2
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-2619
Mailing Address - Country:US
Mailing Address - Phone:347-301-5003
Mailing Address - Fax:
Practice Address - Street 1:221 WEST GRAND AVENUE
Practice Address - Street 2:SUITE 20
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645
Practice Address - Country:US
Practice Address - Phone:347-301-5003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00576600225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist