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General NPI Number Information
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NPI Number | 1730342932
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Entity Type | Organization
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Legal Business Name | BAY RIDGE FAMILY MEDICAL DOCTOR P.C
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 01/31/2014
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Provider Practice Location Address
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Address Line | 364 86TH ST
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City | BROOKLYN
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State | NY
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Zip | 11209-5002
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Country | US
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Telephone | 718-845-8686
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Fax | 718-845-8688
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Provider Business Mailing Address
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Address Line | 415 LITTLE CLOVE RD
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City | STATEN ISLAND
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State | NY
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Zip | 10301-4126
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Country | US
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Telephone | 718-845-8686
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Fax | 718-845-8688
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Authorized Official
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Title or Position | M.D
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Name | NANCY S YANG
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Credential | MD
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Telephone | 718-745-8686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 209272
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License Number State | NY
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