Healthcare Provider Details

I. General information

NPI: 1205372216
Provider Name (Legal Business Name): BY WOUND CARE INTERNAL MEDICINE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 S BROADWAY STE 114
WHITE PLAINS NY
10601
US

IV. Provider business mailing address

34 S BROADWAY STE 114
WHITE PLAINS NY
10601-4432
US

V. Phone/Fax

Practice location:
  • Phone: 914-422-5712
  • Fax: 914-422-5714
Mailing address:
  • Phone: 914-422-5712
  • Fax: 914-422-5714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number264837
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number264837
License Number StateNY

VIII. Authorized Official

Name: DR. BYOUNG WOO YANG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 914-422-5712