Provider Demographics
NPI:1083715932
Name:YU, LEESA YEN YOAN (PA)
Entity Type:Individual
Prefix:MS
First Name:LEESA
Middle Name:YEN YOAN
Last Name:YU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1345 RXR PLZ FL 13
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11556-1301
Mailing Address - Country:US
Mailing Address - Phone:516-453-0435
Mailing Address - Fax:646-846-3283
Practice Address - Street 1:996 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2511
Practice Address - Country:US
Practice Address - Phone:631-736-5900
Practice Address - Fax:631-736-5908
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2019-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY011372363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY00246075Medicaid