Healthcare Provider Details

I. General information

NPI: 1780147397
Provider Name (Legal Business Name): YUNG-TIAN ANJOLIE GAU MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-2306
US

IV. Provider business mailing address

175 ELIZABETH BLACKWELL STREET NEUROLOGY ADMINISTRATIVE OFFICE, JACOBSEN HALL RM. 813
SYRACUSE NY
13210
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-4243
  • Fax:
Mailing address:
  • Phone: 315-464-4243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: