Provider Demographics
NPI:1194960658
Name:YASIN, TIMUR (MD)
Entity type:Individual
Prefix:DR
First Name:TIMUR
Middle Name:
Last Name:YASIN
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 1:309 E MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2844
Mailing Address - Country:US
Mailing Address - Phone:631-360-2200
Mailing Address - Fax:631-360-1328
Practice Address - Street 1:309 E MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2844
Practice Address - Country:US
Practice Address - Phone:631-360-2200
Practice Address - Fax:631-360-1328
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252485-1208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation