Provider Demographics
NPI:1235102468
Name:YANG, ANDREA (OD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 JACKSON ST
Mailing Address - Street 2:UNIT 910
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-9229
Mailing Address - Country:US
Mailing Address - Phone:212-938-5897
Mailing Address - Fax:
Practice Address - Street 1:33 WEST 42ND STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-8005
Practice Address - Country:US
Practice Address - Phone:212-938-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006265152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244528Medicaid
NYU84727Medicare UPIN
C148G1Medicare ID - Type Unspecified