Healthcare Provider Details

I. General information

NPI: 1730521212
Provider Name (Legal Business Name): DR. DERRICK YIP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 CASTLE POINT RD
WAPPINGERS FALLS NY
12590-7004
US

IV. Provider business mailing address

20431 29TH AVE
BAYSIDE NY
11360-2318
US

V. Phone/Fax

Practice location:
  • Phone: 845-831-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number057044
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number057044
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: