Provider Demographics
NPI:1063766343
Name:YU, YOUNG
Entity type:Individual
Prefix:
First Name:YOUNG
Middle Name:
Last Name:YU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4119 60TH ST
Mailing Address - Street 2:3C
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4987
Mailing Address - Country:US
Mailing Address - Phone:917-868-0407
Mailing Address - Fax:
Practice Address - Street 1:4119 60TH ST
Practice Address - Street 2:3C
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4987
Practice Address - Country:US
Practice Address - Phone:917-868-0407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033606-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic