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General NPI Number Information
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NPI Number | 1548589781
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Entity Type | Organization
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Legal Business Name | JERICHO ENDOSCOPY , PLLC
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Dates
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Enumeration Date | 05/27/2010
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Last Update Date | 05/27/2010
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Provider Practice Location Address
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Address Line | 1880 E JERICHO TPKE FL 1
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City | HUNTINGTON
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State | NY
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Zip | 11743-5766
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Country | US
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Telephone | 631-629-4628
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Fax | 631-629-4629
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Provider Business Mailing Address
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Address Line | 1880 E JERICHO TPKE # 1FL
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City | HUNTINGTON
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State | NY
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Zip | 11743-5766
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Country | US
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Telephone | 631-629-4628
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Fax | 631-629-4629
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Authorized Official
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Title or Position | M.D.
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Name | DR. ALAN C YAO
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Credential |
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Telephone | 631-629-4628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 204609
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License Number State | NY
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