Healthcare Provider Details

I. General information

NPI: 1780758045
Provider Name (Legal Business Name): POLINE YIU RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 CENTRE ST SUITE 609
NEW YORK NY
10013-4408
US

IV. Provider business mailing address

139 CENTRE ST SUITE 609
NEW YORK NY
10013-4408
US

V. Phone/Fax

Practice location:
  • Phone: 212-431-4309
  • Fax: 212-343-8104
Mailing address:
  • Phone: 212-431-4309
  • Fax: 212-343-8104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number23-011313
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: