MEDICARE: SYNG YONG KWAK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	136847	NY

General Provider Information

NPI Number	:	1316030042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYNG YONG KWAK MD

Provider Business Mailing Address
First Line	:	2144 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3916
Country	:	US
Telephone Number	:	718-273-8052
Fax Number	:	718-370-3736

Provider Business Practice Location Address
First Line	:	2144 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3916
Country	:	US
Telephone Number	:	718-273-8052
Fax Number	:	718-370-3736

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	05/13/2009

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