Provider Demographics
NPI:1164514964
Name:L & Y MEDICAL ASSOCIATE PC
Entity Type:Organization
Organization Name:L & Y MEDICAL ASSOCIATE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:WEINING
Authorized Official - Middle Name:W
Authorized Official - Last Name:LIANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-321-7558
Mailing Address - Street 1:36-09 MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354
Mailing Address - Country:US
Mailing Address - Phone:718-321-7558
Mailing Address - Fax:718-321-3555
Practice Address - Street 1:36-09 MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-321-7558
Practice Address - Fax:718-321-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01849985Medicaid
NY01849985Medicaid
G42608Medicare UPIN