Healthcare Provider Details

I. General information

NPI: 1447177506
Provider Name (Legal Business Name): JUNG A YEON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 HIGH ST
RYE NY
10580-1506
US

IV. Provider business mailing address

66 HIGH ST
RYE NY
10580-1506
US

V. Phone/Fax

Practice location:
  • Phone: 914-426-5164
  • Fax:
Mailing address:
  • Phone: 914-426-5164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF360073-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: