Provider Demographics
NPI:1376834218
Name:YUAN, MEILONG (PA)
Entity Type:Individual
Prefix:MR
First Name:MEILONG
Middle Name:
Last Name:YUAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5645 MAIN ST
Mailing Address - Street 2:W-LL300
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5045
Mailing Address - Country:US
Mailing Address - Phone:718-303-3720
Mailing Address - Fax:718-939-1167
Practice Address - Street 1:5645 MAIN ST
Practice Address - Street 2:W-LL300
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5045
Practice Address - Country:US
Practice Address - Phone:718-303-3720
Practice Address - Fax:718-939-1167
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY014786363AS0400X
NY'014786363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400136105Medicare PIN
NYG400085562Medicare PIN