Healthcare Provider Details

I. General information

NPI: 1073688073
Provider Name (Legal Business Name): NICOLAS YAP GNO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 ARTHUR AVE
BRONX NY
10458
US

IV. Provider business mailing address

2445 ARTHUR AVE
BRONX NY
10458
US

V. Phone/Fax

Practice location:
  • Phone: 646-477-9631
  • Fax: 718-733-2037
Mailing address:
  • Phone: 646-477-9636
  • Fax: 718-733-2037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number115291
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number115291
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: