Provider Demographics
NPI:1851575005
Name:JON YARDNEY, M.D. LLC
Entity type:Organization
Organization Name:JON YARDNEY, M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YARDNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-688-5266
Mailing Address - Street 1:241 B CONESTOGA RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3916
Mailing Address - Country:US
Mailing Address - Phone:610-688-5266
Mailing Address - Fax:
Practice Address - Street 1:241 B CONESTOGA RD
Practice Address - Street 2:SUITE B
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3916
Practice Address - Country:US
Practice Address - Phone:610-688-5266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027508E302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA067802Medicare PIN
PAB34440Medicare UPIN