Healthcare Provider Details

I. General information

NPI: 1376269373
Provider Name (Legal Business Name): GREGORY YIP NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W 168TH ST
NEW YORK NY
10032-3725
US

IV. Provider business mailing address

224 HAMBURG TPKE
WAYNE NJ
07470-2168
US

V. Phone/Fax

Practice location:
  • Phone: 225-800-7470
  • Fax:
Mailing address:
  • Phone: 225-800-7470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01380300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: