Healthcare Provider Details

I. General information

NPI: 1558848762
Provider Name (Legal Business Name): PRESTON YU PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL
NEW YORK NY
10029-6504
US

IV. Provider business mailing address

628 WILSON AVE APT 2R
BROOKLYN NY
11207-1575
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-1653
  • Fax: 212-289-6393
Mailing address:
  • Phone: 585-944-0760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number022291
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: