MEDICARE: DR. NANCY YANG M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	209272	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407005556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY YANG M.D

Provider Business Mailing Address
First Line	:	415 LITTLE CLOVE RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-4126
Country	:	US
Telephone Number	:	718-745-8685
Fax Number	:	718-745-8688

Provider Business Practice Location Address
First Line	:	364 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-5002
Country	:	US
Telephone Number	:	718-745-8685
Fax Number	:	718-745-8688

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2008
Last Update Date	:	01/15/2014

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