Provider Demographics
NPI:1407005689
Name:J C YU MDPC
Entity Type:Organization
Organization Name:J C YU MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIAN
Authorized Official - Middle Name:CHU
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-360-0005
Mailing Address - Street 1:236 CEDRUS AVE
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4515
Mailing Address - Country:US
Mailing Address - Phone:631-360-0005
Mailing Address - Fax:631-368-1113
Practice Address - Street 1:227 MOUNT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2709
Practice Address - Country:US
Practice Address - Phone:631-360-0005
Practice Address - Fax:631-368-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY56A911Medicare PIN