Healthcare Provider Details

I. General information

NPI: 1689859480
Provider Name (Legal Business Name): NY INTEGRATIVE MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4809 8TH AVE
BROOKLYN NY
11220-2213
US

IV. Provider business mailing address

4809 8TH AVE
BROOKLYN NY
11220-2213
US

V. Phone/Fax

Practice location:
  • Phone: 212-925-8839
  • Fax:
Mailing address:
  • Phone: 212-925-8839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number204326
License Number StateNY

VIII. Authorized Official

Name: LUGUANG YANG
Title or Position: PRESIDENT
Credential: MD
Phone: 212-925-8839