MEDICARE: JINSU YO AGNP-C, AGPCNP-BC

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	363LG0600X	Gerontology Nurse Practitioner	F312517	NY
2	363LA2200X	Adult Health Nurse Practitioner	F312517	NY

General Provider Information

NPI Number	:	1972459030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JINSU YO AGNP-C, AGPCNP-BC

Provider Business Mailing Address
First Line	:	255 EXECUTIVE DR STE 210
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-1711
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 EXECUTIVE DRIVE, SUITE 210
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803
Country	:	US
Telephone Number	:	516-687-9444
Fax Number	:

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

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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