Healthcare Provider Details

I. General information

NPI: 1356661920
Provider Name (Legal Business Name): WILBERT YEUNG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 06/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 ESSEX ST STE 206
HACKENSACK NJ
07601-4035
US

IV. Provider business mailing address

75 ESSEX ST STE 206
HACKENSACK NJ
07601-4035
US

V. Phone/Fax

Practice location:
  • Phone: 908-208-8250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number25MA08575400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number25MA08575400
License Number StateNJ

VIII. Authorized Official

Name: DR. WILBERT YEUNG
Title or Position: SOLE MEMBER
Credential: M.D.
Phone: 908-208-8250