Basic Information
| Provider Information | |||||||||
| NPI: | 1629280201 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MYAING | ||||||||
| FirstName: | YIN | ||||||||
| MiddleName: | YIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1351 ROUTE 55 STE 200 | ||||||||
| Address2: | |||||||||
| City: | LAGRANGEVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125405128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454759661 | ||||||||
| FaxNumber: | 8454759938 | ||||||||
| Practice Location | |||||||||
| Address1: | 45 READE PL | ||||||||
| Address2: | |||||||||
| City: | POUGHKEEPSIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454548500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2007 | ||||||||
| LastUpdateDate: | 09/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 255640 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 255640 | NY | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 03177915 | 05 | NY | MEDICAID |