Healthcare Provider Details

I. General information

NPI: 1912488974
Provider Name (Legal Business Name): MIAE YU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96-10 METROPOLITAN AVE
FOREST HILLS NY
11375-6625
US

IV. Provider business mailing address

55 WATER ST FL 2
NEW YORK NY
10041-0010
US

V. Phone/Fax

Practice location:
  • Phone: 718-459-0400
  • Fax: 718-670-6479
Mailing address:
  • Phone: 646-680-2888
  • Fax: 516-542-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF339531
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: