Healthcare Provider Details

I. General information

NPI: 1205091527
Provider Name (Legal Business Name): YU-LAN MARY YING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 BERGEN STREET SUITE 8100
NEWARK NJ
07103-2425
US

IV. Provider business mailing address

90 BERGEN ST SUITE 8100
NEWARK NJ
07103-2425
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-4588
  • Fax:
Mailing address:
  • Phone: 973-972-4588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number205398
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number436256
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT182471
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number25MA09529800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: