Provider Demographics
NPI:1356669170
Name:JERICHO AMBULATORY ENDOSCOPY , PLLC
Entity Type:Organization
Organization Name:JERICHO AMBULATORY ENDOSCOPY , PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:YAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-629-4628
Mailing Address - Street 1:1880 E JERICHO TPKE
Mailing Address - Street 2:1F/L
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:631-629-4628
Mailing Address - Fax:631-629-4629
Practice Address - Street 1:1880 E JERICHO TPKE
Practice Address - Street 2:1F/L
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:631-629-4628
Practice Address - Fax:631-629-4629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204609261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical