Healthcare Provider Details

I. General information

NPI: 1902701014
Provider Name (Legal Business Name): MINJEONG YI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E MILL DR APT 1F
GREAT NECK NY
11021-4078
US

IV. Provider business mailing address

1 E MILL DR APT 1F
GREAT NECK NY
11021-4078
US

V. Phone/Fax

Practice location:
  • Phone: 516-319-9696
  • Fax:
Mailing address:
  • Phone: 516-319-9696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF312918-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: