Healthcare Provider Details

I. General information

NPI: 1013513688
Provider Name (Legal Business Name): SAU YEE YIP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3147 KENNEDY BLVD
NORTH BERGEN NJ
07047-2379
US

IV. Provider business mailing address

3147 KENNEDY BLVD
NORTH BERGEN NJ
07047-2379
US

V. Phone/Fax

Practice location:
  • Phone: 201-865-7050
  • Fax:
Mailing address:
  • Phone: 201-865-7050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RS00580300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: