Provider Demographics
NPI:1063880508
Name:YANNECK, MARNI (MSED)
Entity type:Individual
Prefix:MS
First Name:MARNI
Middle Name:
Last Name:YANNECK
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 DEVON RD
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-3534
Mailing Address - Country:US
Mailing Address - Phone:518-439-5256
Mailing Address - Fax:
Practice Address - Street 1:28 DEVON RD
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-3534
Practice Address - Country:US
Practice Address - Phone:518-439-5256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY452628921174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist