Provider Demographics
NPI:1881624179
Name:MARDY, YVAN (MD)
Entity type:Individual
Prefix:MR
First Name:YVAN
Middle Name:
Last Name:MARDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23055 EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-3639
Mailing Address - Country:US
Mailing Address - Phone:718-527-7415
Mailing Address - Fax:
Practice Address - Street 1:24318 MERRICK BLVD
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-1460
Practice Address - Country:US
Practice Address - Phone:718-481-8778
Practice Address - Fax:718-978-5534
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185993207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF44917Medicare UPIN