Healthcare Provider Details

I. General information

NPI: 1255993853
Provider Name (Legal Business Name): VIVIAN YEAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 11/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 1ST ST
MINEOLA NY
11501-3957
US

IV. Provider business mailing address

7234 AUSTIN ST APT D5
FOREST HILLS NY
11375-5366
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-0333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number023563
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: