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General NPI Number Information
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NPI Number | 1124200753
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Entity Type | Organization
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Legal Business Name | NY INTEGRATIVE MEDICINE PC
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Dates
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Enumeration Date | 12/05/2007
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Last Update Date | 12/26/2007
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Provider Practice Location Address
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Address Line | 32 E BROADWAY RM 501
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City | NEW YORK
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State | NY
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Zip | 10002-6891
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Country | US
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Telephone | 212-925-8839
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Fax | 212-226-8498
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Provider Business Mailing Address
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Address Line | 32 E BROADWAY RM 501
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City | NEW YORK
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State | NY
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Zip | 10002-6891
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Country | US
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Telephone | 212-925-8839
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Fax | 212-226-8498
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Authorized Official
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Title or Position | PRESIDENT
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Name | LUGUANG YANG
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Credential | MD
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Telephone | 212-925-8839
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | 204326
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License Number State | NY
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