Healthcare Provider Details

I. General information

NPI: 1336038207
Provider Name (Legal Business Name): PHILIP YEUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270-05 76TH AVENUE
NEW HYDE PARK NY
11040
US

IV. Provider business mailing address

1 OTT PL
COMMACK NY
11725-2023
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number650404
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number650404
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: