Provider Demographics
NPI:1306817119
Name:YU, REBECO CHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECO
Middle Name:CHAN
Last Name:YU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MONTAUK HWY
Mailing Address - Street 2:SUITE U
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4418
Mailing Address - Country:US
Mailing Address - Phone:631-321-0606
Mailing Address - Fax:631-321-1948
Practice Address - Street 1:500 MONTAUK HWY
Practice Address - Street 2:SUITE U
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4418
Practice Address - Country:US
Practice Address - Phone:631-321-0606
Practice Address - Fax:631-321-1948
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110127-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00196447Medicaid
NY110127-1OtherLICENSE
NYB16455Medicare UPIN
NY559831Medicare ID - Type Unspecified