Basic Information
| Provider Information | |||||||||
| NPI: | 1669543682 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YU | ||||||||
| FirstName: | HONG | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 161 RIVERSIDE DR | ||||||||
| Address2: | SUITE 306 | ||||||||
| City: | BINGHAMTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 139054176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077986700 | ||||||||
| FaxNumber: | 6077986745 | ||||||||
| Practice Location | |||||||||
| Address1: | 161 RIVERSIDE DR | ||||||||
| Address2: | SUITE 306 | ||||||||
| City: | BINGHAMTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 139054176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077986700 | ||||||||
| FaxNumber: | 6077986745 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 214870 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01982443 | 05 | NY | MEDICAID |