Healthcare Provider Details

I. General information

NPI: 1902729858
Provider Name (Legal Business Name): NIANHWA YU MSED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLINE YU MSED

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 HALLOCK AVE
PORT JEFFERSON STATION NY
11776-1217
US

IV. Provider business mailing address

4 HARTMAN HILL RD
HUNTINGTON NY
11743-6047
US

V. Phone/Fax

Practice location:
  • Phone: 631-473-4284
  • Fax: 631-331-2204
Mailing address:
  • Phone: 631-473-4284
  • Fax: 631-331-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: