Healthcare Provider Details

I. General information

NPI: 1124200753
Provider Name (Legal Business Name): NY INTEGRATIVE MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 12/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 E BROADWAY RM 501
NEW YORK NY
10002-6891
US

IV. Provider business mailing address

32 E BROADWAY RM 501
NEW YORK NY
10002-6891
US

V. Phone/Fax

Practice location:
  • Phone: 212-925-8839
  • Fax: 212-226-8498
Mailing address:
  • Phone: 212-925-8839
  • Fax: 212-226-8498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number204326
License Number StateNY

VIII. Authorized Official

Name: LUGUANG YANG
Title or Position: PRESIDENT
Credential: MD
Phone: 212-925-8839