Provider Demographics
NPI:1225076961
Name:YANG, SHERRY (MD)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 WILLOWBROOK BLVD
Mailing Address - Street 2:SUITE 411
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470
Mailing Address - Country:US
Mailing Address - Phone:973-256-4111
Mailing Address - Fax:973-256-3719
Practice Address - Street 1:57 WILLOWBROOK BLVD
Practice Address - Street 2:SUITE 411
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7045
Practice Address - Country:US
Practice Address - Phone:973-256-4111
Practice Address - Fax:973-256-3719
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07228900207WX0110X
NJMA72289207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
H29775Medicare UPIN
049032Q5HMedicare ID - Type Unspecified