Healthcare Provider Details

I. General information

NPI: 1588185029
Provider Name (Legal Business Name): STEPHEN WING KIN YIP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7105 3RD AVE
BROOKLYN NY
11209-1308
US

IV. Provider business mailing address

7105 3RD AVE # 523
BROOKLYN NY
11209-1308
US

V. Phone/Fax

Practice location:
  • Phone: 718-865-9333
  • Fax:
Mailing address:
  • Phone: 718-865-9333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF341615-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: