Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 013247 | NY |
NPI | 1073898870 |
---|---|
Provider Name | Shirley Yang |
First Address | Jamaica, NY 11432-1451 |
Second Address | Jamaica, NY 11432-1451 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2011 |
Last Update Date | 12/10/2011 |