Provider Demographics
NPI:1104267517
Name:YIP, CONNIE (NP)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:YIP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E 43RD ST FL 7
Mailing Address - Street 2:SUITE 444
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017
Mailing Address - Country:US
Mailing Address - Phone:917-858-1232
Mailing Address - Fax:866-282-5533
Practice Address - Street 1:211 E 43RD ST FL 7
Practice Address - Street 2:SUITE 444
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017
Practice Address - Country:US
Practice Address - Phone:917-858-1232
Practice Address - Fax:866-282-5533
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-13
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401652363LP0808X
NY6436581163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse