Healthcare Provider Details

I. General information

NPI: 1447900329
Provider Name (Legal Business Name): YANGTIAN YI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 E 29TH ST
BAYONNE NJ
07002-4654
US

IV. Provider business mailing address

29 E 29TH ST
BAYONNE NJ
07002-4654
US

V. Phone/Fax

Practice location:
  • Phone: 201-858-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA12986900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: